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Early Gastric Cancer‐like Advanced Gastric Cancer / Submucosal Tumor‐like Lesion · Journal article
Den Open · August 14, 2026
Early or partial results. Treat as a signal, not a conclusion.
This case report describes a man in his 70s with early gastric cancer-like advanced gastric carcinoma with focal enteroblastic differentiation and subserosal invasion that was initially underestimated on preoperative endoscopy. A subtle submucosal tumor-like protrusion was only recognized retrospectively after clinicopathological correlation, highlighting the diagnostic difficulty in depth assessment for this rare entity.
Single case report. A man in his 70s referred for treatment of a gastric lesion detected during screening endoscopy; active Helicobacter pylori infection confirmed by serology (95 U/mL); history of prostate cancer with lung metastasis controlled with leuprorelin and enzalutamide.. Intervention: Endoscopic submucosal dissection (ESD) performed using GIF-XZ1200 endoscope; followed by additional surgical resection when ESD specimen showed positive vertical margin.. Saitama Medical University International Medical Center, Japan.
A 20 mm depressed lesion on the lesser curvature of the antrum was initially diagnosed as intramucosal cancer (cT1a) but was found to have subserosal invasion (pT3 [SS]) on surgical pathology ESD specimen showed submucosal invasion with positive vertical margin (pT1b2, SM2, 3 mm, pVM1), requiring additional surgical resection Final surgical specimen demonstrated tubular adenocarcinoma (tub2 por1/tub1) with focal enteroblastic differentiation, subserosal invasion, and venous invasion (V1c) but without lymph node metastasis
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This case illustrates the diagnostic challenge of depth assessment in early gastric cancer-like advanced gastric carcinoma and suggests that a subtle submucosal tumor-like change adjacent to a superficial-appearing lesion may represent deep invasion. Clinicians should integrate endoscopic, intraoperative, and pathological findings to avoid underestimation of tumor depth and inappropriate selection of endoscopic therapy.
A single case report describing a diagnostic pitfall in early gastric cancer-like advanced gastric cancer, raising awareness of a rare entity but providing no generalizable evidence or outcome data to guide practice.
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This case illustrates the diagnostic challenge of depth assessment in early gastric cancer-like advanced gastric carcinoma and suggests that a subtle submucosal tumor-like change adjacent to a superficial-appearing lesion may represent deep invasion. Clinicians should integrate endoscopic, intraoperative, and pathological findings to avoid underestimation of tumor depth and inappropriate selection of endoscopic therapy.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Early gastric cancer (EGC)-like advanced gastric cancer (AGC) is a rare entity that mimics superficial disease despite deep invasion. We report a case of EGC-like AGC with focal enteroblastic differentiation in which subserosal invasion was underestimated because of its superficially appearing endoscopic features. A subtle submucosal tumor (SMT)-like change was recognized only retrospectively after clinicopathological correlation. Endoscopy revealed a depressed 0-IIc-appearing lesion with fold convergence toward a single point, leading to a diagnosis of UL1; however, no mound-like elevation was observed. Retrospective review identified a subtle SMT-like protrusion on the anterior wall, slightly apart from the main depression. Endoscopic submucosal dissection (ESD) was performed for presumed EGC. During ESD, a whitish cord-like structure extending from the muscularis propria was identified at the corresponding site. The ESD specimen showed submucosal invasion with a positive vertical margin, and additional surgical resection revealed subserosal invasion. Histopathological examination of the surgical specimen demonstrated tubular adenocarcinoma (tub2>por1/tub1) with focal enteroblastic differentiation and subserosal invasion (pT3 [SS]) without lymph node metastasis but with venous invasion (V1c). Immunohistochemistry showed CK7 positivity, CK20 negativity, and partial expression of CDX2, glypican-3, and SALL4, whereas AFP was negative. Clinicopathological correlation showed that the retrospectively recognized SMT-like change corresponded to the deepest invasive component. This case highlights the difficulty of preoperative depth assessment in EGC-like AGC. Careful integration of endoscopic, intraoperative, and clinicopathological findings may help avoid underestimation of tumor depth.
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