Journal
GASTRIC CANCER
Volume 24, Issue 5, Pages 1160-1166Publisher
SPRINGER
DOI: 10.1007/s10120-021-01189-2
Keywords
Gastric cancer; Endoscopic submucosal dissection; Neoplasm recurrence
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A 93-year-old female underwent curative endoscopic submucosal dissection for intramucosal gastric cancer, which resulted in a longitudinal laceration at the esophagogastric junction. A new lesion was found 6 months later, requiring a second resection with similar features to the original lesion, indicating recurrence due to implantation of tumor cells in the mucosal laceration. Endoscopists should be aware of the risk of implantation after gastric ESD.
A 93-year-old female underwent curative endoscopic submucosal dissection (ESD) for intramucosal gastric cancer (70 mm in diameter) in the antrum. The lesion showed an irregularly villous structure covered with mucus. En bloc resection was performed. The large resected specimen induced a longitudinal laceration on the right wall of the esophagogastric junction (EGJ) during retrieval. Unavoidably, we segmented the specimen in the stomach to facilitate retrieval. Histopathological evaluation of the specimen revealed well-to-moderately differentiated tubular and papillary adenocarcinoma. A new elevated lesion (15 mm in diameter) was found at the gastric side of the EGJ laceration scar 6 months after the first ESD, necessitating a second resection with ESD. Endoscopic, histopathological, and immunohistochemical features of the new lesion resembled those of the antral lesion. We assessed the new lesion as a recurrence of cancer caused by implantation of tumor cells in the mucosal laceration after ESD. We experienced recurrence caused by implantation of tumor cells in a mucosal laceration after curative gastric ESD. Endoscopist should be aware of the risk of implantation after gastric ESD.
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