EXTREMELY WELL-DIFFERENTIATED ADENOCARCINOMA OF THE STOMACH: TWO CASES OF AN ITALIAN CENTER

Aims Extremely Well-Differentiated Adenocarcinoma (EWDA) of the stomach is a rare type of gastric cancer (GC) which accounts 0.1%–0.6% of all GC. According to series published, mainly in Japan, it usually affects males ranging from 40 to 80 years old and it is located in the upper or middle third of the stomach. Since it mimics normal mucosa or intestinal metaplasia, surgical resection is often needed to establish the diagnosis.

Methods A retrospective study was performed evaluating all consecutive patients diagnosed with GC at our center from May 2009 to March 2019.

Results Out of 1000 GC, two cases (0.2%) of EWDA were identified. A 92 years old male underwent esophagogastroduodenoscopy (EGD) for weight loss. An ulcerated lesion of angulus and prepiloric region was discovered. Biopsies showed active gastritis with H. Pylori infection, mild atrophy and intestinal metaplasia. Follow-up EGDs showed persistency of the ulcer, with no malignancy at sampling, but with progressive narrowing of the lumen. Due to persisting vomiting despite endoscopic dilatation, sub-total gastrectomy was performed. Final diagnosis showed EWDA of the stomach. Due to epigastric pain, a 68 years old female underwent EGD that showed an ulcer in the middle third of the stomach along the great curvature. Biopsies showed inflammation with intestinal metaplasia. At follow-up EGD, biopsies of the persistent ulcer showed GC. Total gastrectomy was performed and final diagnosis showed EWDA of the stomach.

Conclusions EWDA of the stomach is a rare disease of challenging diagnosis at endoscopic sampling. Surgical resection is needed for diagnosis.

Publication History

Article published online:
14 April 2022