Intramucosal ("Early") Gastric Cancer
Left: 72 year-old man undergoing endoscopy for evaluation of abdominal pain. Endoscopy revealed a subtle, 2-3 cm focus of barely raised, nodular mucosa with normal color, on the posterior wall of the distal gastric body. The antrum and pylorus are visible in the background of this photo. Biopsies from the lesion revealed adenocarcinoma, and the patient was referred for surgical resection. The surgical specimen showed the lesion to be intra-mucosal, with invasion of the lamina propria but not into the muscularis mucosa.
Right: 67 year-old woman with unexplained weight loss as her only symptom. Endoscopy demonstrated mucosal irregularity with erosion and some thickening, but no frank ulceraton. Biopsy revealed adenocarcinoma. At surgery, the malignancy involved the mucosa and submucosa but did not invade the muscular layer. Lymph nodes were negative.
Left: 76 year-old woman who had undergone chemotherapy for a gastric MALT lymphoma, was found on post-treatment endoscopy to have a subtle raised lesion which ultimately proved to be a localized adenocarcinoma. There was no evidence of residual lymphoma.
Right: Same lesion as in center image, two weeks later at repeat endoscopy to obtain confirmatory biopsies. Residual signs of having been biopsied two weeks earlier can be seen.
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