J Korean Surg Soc.  2013 Feb;84(2):118-122. 10.4174/jkss.2013.84.2.118.

Two cases of mucinous adenocarcinoma of the stomach mistaken as submucosal tumor

• Yu BC
• Lee WK

• KMID: 2145000
• DOI: http://doi.org/10.4174/jkss.2013.84.2.118

Abstract

A gastric carcinoma with the endoscopic features resembling submucosal tumor (SMT) is rare, and reportedly account for only 0.1% to 0.63% of all resected gastric carcinomas. The preoperative diagnosis of SMT-like gastric carcinoma is challenging, and thus, diagnosis is usually made intraoperatively or postoperatively. Furthermore, mucinous adenocarcinoma is an uncommon histologic subtype of gastric carcinoma characterized as an elevated lesion resembling SMT due to abundant mucin pools in submucosa. Here, we report two cases in which a gastric mucinous adenocarcinoma was mistaken as a SMT.

Keyword

Submucosal tumor; Gastric neoplasms; Adenocarcinoma; Mucinous

MeSH Terms

Adenocarcinoma
Adenocarcinoma, Mucinous
Gastric Mucins
Mucins
Stomach
Stomach Neoplasms
Gastric Mucins
Mucins

Figure

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  Fig. 1 (A) Endoscopy revealed two large round, protruding masses in the antrum without a mucosal abnormality. (B) Endoscopic ultrasonography showed two large cystic lesions containing nonhomogenous mixed echoic masses in the proper muscle layer, without nearby lymph node enlargement. (C) Computed tomography revealed a -3.1 cm sized multilocular cystic mass in the submucosal portion of the pylorus.

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  Fig. 2 (A) Cross section showing tumor infiltration into proper muscle and subserosa with normally appearing overlying mucosa. (B) The tumor was located under the intact mucosa (H&E, ×12.5). (C) The tumor showing focal papillary growth and extracelluar pools of mucin (H&E, ×100).

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  Fig. 3 (A) Endoscopy revealed an extrinsic mass effect in the lesser curvature of the midbody, and there was redness of mucosa around the lesion. However there was no evident erosion. (B) Computed tomography revealed a -5 cm sized mass with partial necrotic change in the lesser curvature side of the stomach body and multiple lymphadenopathy.

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  Fig. 4 (A) The mucosal surface is slightly red in comparison with the surrounding gastric mucosa but no erosion is evident. (B) On cross section, the tumor was found to have infiltrated subserosa. The tumor had a brownish tan color and necrotic change was observed in its center. (C) Low power histologic examination reveals most of the cancer cells are covered with noncancerous epithelium (H&E, ×12.5).

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