An uncommon early gastric cancer with enteroblastic differentiation

A 73-year-old man with a 25-year history of liver cirrhosis has been treated for liver cancer for 13 years. His cancer is currently well-controlled, and his AFP is normal. The gastroscopy revealed a clearly-border whitish mucosa with a frost-like coating in the greater curvature of gastric body. Under magnification, the lesion revealed that the micro-structure(MS) of the mucosal surface are faintly discernible, with the marginal crypt epithelium(MCE) showing irregular and closely spaced villous projections. The color tone of the IIb region appears the same with the surrounding mucosa. The micro-vascular(MV) structure is invisible. The crystal violet staining reveals the presence of micro-structures. Considering early-stage lesions, we successfully performed ESD treatment. The final diagnosis was gastric adenocarcinoma with enteroblastic differentiation (tub2>por1). We did the mapping to better evaluate the lesion. The main lesion is located in the mucosal layer, with small foci-infiltrating into the submucosal layer to a depth of 196um. Pathology about specimen No.A7 showed biopsy position. The epithelial cells were cubic, the atypia was significant, and the cytoplasm was transparent and vacuole-like. Immunohistochemistry supported the diagnosis of GAED. The additional surgery was recommended to reduce the risk of lymph node metastasis. However, the patient and their family refused it because of the complexity of the patient's condition. 14months after endoscopic treatment, there has been no recurrence of the lesion, and the patient is living well without any digestive discomfort.