Fig. 1Gastroscopic finding. A 1.5-cm superficial depressed lesion surrounded by multiple nodularity with overlying normal mucosa is observed at the mid body of the stomach. In the center of the lesion, spontaneous bleeding is noted.
Fig. 2Gross finding. (A) An endoscopic submucosal dissection (ESD) specimen, measuring 4×3.5×0.5-cm shows 1.5×0.5-cm superficial depressed lesion in the center and multiple markings on the periphery. (B) Mapping of ESD specimen reveals 1.5×0.5-cm-sized, well-differentiated, tubular adenocarcinoma (black color) in the center and gastritis cystica profunda (blue color) multifocally. An inverted hyperplastic polyp is located close to the well-differentiated tubular adenocarcinoma (red color). LC, lesser curvature; GC, greater curvature.
Fig. 3Microscopic finding. (A) Low power view of the lesion shows well-differentiated adenocarcinoma in the mucosa (black box), gastritis cystica profunda in the submucosa (gray box), and inverted hyperplastic polyp in the submucosa (white box) at the same sight (H&E stain, ×10). (B) Well-differentiated adenocarcinoma is noted in the epithelium and lamina propria (black box, H&E stain, ×100). (C) It shows hyperplasia and cystic dilatation of the gastric glands extending to the submucosa layer (gray box, H&E stain, ×40). (D) It reveals a submucosal mass composed of proliferative glandular epithelial cells showing papillary and glandular growth (white box, H&E stain, ×40).