case_images: PMC10852983_01
case_images: Endoscopic and gross findings. a, b White-light imaging revealed that there was a lesion in the anterior wall of the gastric antrum (a), which was superficially depressed, with a size of 20 mm (b). c Magnifying endoscopy with narrow-band imaging shows irregular microsurface patterns and irregular microvascular patterns, with a demarcation line. d Endoscopic ultrasonography image using a 12-MHz miniature probe. The arrows indicate the areas of suspected infiltration.
case_images: crg-2024-0018-0001-535954_F01.jpg
case_images: PMC10852983_01_crg-2024-0018-0001-535954_F01.jpg
case_images: F1
case_images: A 70-year-old male with no known comorbidities presented to our hospital with an early gastric cancer in the anterior wall of the gastric antrum (Fig. 1a). The lesion was approximately 20 mm in size and superficially depressed (Fig. 1b). Magnifying endoscopy with narrow-banding imaging revealed a clear demarcation line and irregular microvascular and microsurface patterns (Fig. 1c). Endoscopic ultrasonography using a 12-MHz miniature probe revealed that the tumor was within the deep submucosa (Fig. 1d).
case_images: Pathological findings. a Endoscopic submucosal dissection specimen with gross mapping. The tumors were 20 mm in size. The red line area indicates the cancerous area, and the yellow line area indicates where the enteroblastic differentiation was seen on the surface layer. b The tumor was composed of dilated or slit-like branching tubules of variable diameter that infiltrated deeply into the submucosa. c Inside the tumor, adhesive glandular ducts and glandular ducts with necrotic material in the lumen are observed. d The tumor cells show partially clear cytoplasm, resembling the fetal digestive tract. Magnification: x40 (b), x100 (c), and x400 (d).
case_images: crg-2024-0018-0001-535954_F02.jpg
case_images: PMC10852983_01_crg-2024-0018-0001-535954_F02.jpg
case_images: F2
case_images: The endoscopically resected specimen was 30 mm in size and showed a superficial depressed tumor, which was found to be 20 mm in size (Fig. 2a). Histological examination revealed that the tumor was composed of dilated or slit-like branching tubules of variable diameters that infiltrated deeply into the submucosa (Fig. 2b). Adhesive glandular ducts and glandular ducts with necrotic material in the lumen were observed inside the tumor (Fig. 2c). Atypical glandular ducts with a partially clear cytoplasm were also observed; these resembled the fetal digestive tract (Fig. 2d).
case_images: Immunohistochemical findings. These figures show the same locations on serial sections as much as possible. a Hematoxylin and eosin (HE) staining. Tumor cells have eosinophilic or clear cytoplasm. b Glypican-3. c AFP. Both Glypican-3 and AFP are enteroblastic markers, and both the eosinophilic and clear cytoplasmic portions of HE staining showed areas of expression. Magnification: x400 (a-c).
case_images: crg-2024-0018-0001-535954_F03.jpg
case_images: PMC10852983_01_crg-2024-0018-0001-535954_F03.jpg
case_images: F3
case_images: Immunohistochemically, the tumor cells were positive for Glypican-3 and AFP, with dot-like staining (Fig. 3a-c).