case_images: PMC11805676_01
case_images: Esophagogastroduodenoscopy showing early gastric cancer on the lesser curvature of the upper gastric body.
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case_images: The lesion was preoperatively diagnosed as a type 0-IIc, intramucosal well-differentiated adenocarcinoma, 8 mm in size on the lesser curvature of the upper gastric body (Figure 1).
case_images: Pathological findings. (a) The endoscopic submucosal dissection specimen was made by 2 mm width. The red lines indicate the cancer and the yellow line indicates the submucosal invasion part. (b) Hematoxylin and eosin staining of a section showing submucosal invasion which is indicated by the yellow square. Pathological examination revealed a type 0-IIc lesion without ulceration, 8 x 6 mm in size, which has invaded the submucosa with negative lymphovascular involvement and tumor-free margins. (c) A magnified image of the submucosal invasion part indicated by the yellow square. (d) Immunohistochemical evaluation of desmin staining of submucosal invasion part. The submucosal invasion distance indicated by the green line is 428 microm.
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case_images: The lesion was resected with en bloc resection (Figure 2a). T1b1(SM1; 428 microm below the muscularis mucosae), no ulceration, no lymphovascular invasion, and negative resection margins (Figure 2b-d). The pathological sections were prepared at 2 mm intervals.
case_images: Computed tomography (CT), gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (EOB-MRI), and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET)/CT images 18 months after curative endoscopic submucosal dissection. (a) CT revealed a metastatic liver tumor in S4. (b) FDG-PET/CT showing FDG uptake in the liver. (c, d) EOB-MRI revealed metastatic liver tumors in S4, S5, and S8.
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case_images: ESD, the laboratory studies indicated an increase in CEA of 17.6 ng/mL (normal range, <5 ng/mL), and CA19-9 was within the normal range. EGD did not show local recurrence findings, on the other hand, Abdominal CT detected a metastatic liver tumor in S4 (Figure 3a). 18F-fluorodeoxyglucose (FDG) positron emission tomography/CT showed FDG uptake in the same sites of the liver (Figure 3b). Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) enhanced magnetic resonance imaging revealed metastatic liver tumors in S4, S5, and S8 (Figure 3c,d).