Nobuhiro Takeuchi, Yusuke Nomura, Yu Nishida, Tetsuo Maeda, Hidetoshi Tada and Kazuyoshi Naba
A 72-years-old male visited our institution because of severe abdominal distention. Abdominal computed tomography revealed liver cirrhosis with massive retention of ascites. Ascites was treated using diuretic drugs and albumin preparation. Gastroendoscopy revealed esophageal varices, which was successfully treated with endoscopic variceal ligation. A follow-up gastroendoscopy performed 4 months later revealed the disappearance of esophageal varices and the presence of a depressed lesion on the anterior wall of the lesser curvature of the midgastric body with a small orifice near the anal side of the depressed lesion, suggesting gastric gland heterotopia. A biopsy from the depressed lesion revealed group 5. Endoscopic ultrasonography revealed anechoic lesions in the third layer and type 0-IIc lesion with invasion to the third layer, suggesting that the IIc lesion invaded thesubmucosal layers. On the basis of endoscopic findings, the IIc lesion was considered to be within the submucosal layer; therefore, Endoscopic Submucosal Dissection (ESD) was performed, and pathological findings of the resected specimen revealed moderately differentiated tubular adenocarcinoma within the mucosallayer and multiple cystic dilated lesions in the submucosal layer. The post-ESD course wasuneventful and recurrence or de novo lesion has not been detected by regular gastroendoscopy
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