A case of multiple gastric adenocarcinoma of fundic gland type accidentally found by additional gastrectomy following endoscopic submucosal dissection.

Abstract

An octogenarian male underwent upper gastrointestinal (UGI) endoscopy for an annual surveillance program, which identified a 12 mm type 0-IIa lesion on the posterior wall of the gastric fornix. An endoscopic biopsy was performed, raising suspicion for malignancy. Subsequent endoscopic submucosal dissection (ESD) was conducted, and the final histopathological diagnosis confirmed fundic gland-type gastric adenocarcinoma. The tumor exhibited submucosal invasion to a depth of 1000 μm. No evidence of vascular invasion or residual malignant cells at the resection margins was observed. The patient decided to undergo additional proximal gastrectomy to rule out lymph node metastasis. Laparoscopic proximal gastrectomy was performed, and histopathological evaluation revealed no residual carcinoma at the ESD scar and no evidence of lymph node involvement. However, ten additional lesions of fundic gland-type gastric adenocarcinoma were identified, two of which demonstrated submucosal invasion. Biannual follow-up with endoscopy and contrast-enhanced computed tomography has been performed postoperatively. The patient has remained free of recurrence for three years.