A 55-year-old man visited our hospital for a detailed examination of a gastric submucosal tumor that was first detected 10 years prior. The tumor continued to grow and had developed a depressed area in its center. A histopathological examination of biopsy specimens revealed gastric adenocarcinoma of the fundic gland type (GA-FG). It was diagnosed as T2 based on the invasion depth as determined by white-light endoscopy and endoscopic ultrasonography. A total gastrectomy with lymphadenectomy was performed and a GA-FG in the mucosa and submucosa was confirmed histopathologically. However, there was a gradual transition to an infiltrative tubular adenocarcinoma with poorly differentiated components in the muscular and subserosal layers. Metastasis was identified in a dissected lymph node (LN). This is the first report of a GA-FG progressing to an aggressive cancer with LN metastasis. These findings modify our understanding of the pathophysiology of GA-FG.
Adenocarcinoma* ; Biopsy ; Endoscopy ; Endosonography ; Gastrectomy ; Gastric Mucosa ; Humans ; Lymph Node Excision ; Lymph Nodes* ; Middle Aged ; Mucous Membrane ; Neoplasm Metastasis*

A woman in her 70s was referred to our hospital for epigastric pain. CT showed a 3-cm mass slightly below the cardia. At her request, we adopted a strategy of watchful waiting, but 2 years later CT and endoscopy revealed that the mass had grown to 3.5 cm, and single-incision laparoscopic intragastric resection was performed. The day after surgery, hematemesis was observed. Upper gastrointestinal endoscopy revealed oozing from the staple line at the tumor resection site, and hemostasis was performed. Oral intake was started on postoperative day 4, and the patient was discharged from the hospital on postoperative day 10. The final pathology results showed a low-risk gastrointestinal stromal tumor (GIST). Three years after surgery, there has been no evidence of passage obstruction or recurrence. We discuss the indications and techniques for single-incision laparoscopic intragastric resection and review the literature.