Gastric carcinoma originating from the heterotopic submucosal gastric gland treated by laparoscopy and endoscopy cooperative surgery

Figure 1 Results of pre-operative examinations. A: Endoscopic findings showing a submucosal lesion of 15 mm in diameter on the anterior wall of the upper gastric body near the esophago-gastric junction. The surface was covered with normal gastric mucosa; B: Barium gastrography showed a smooth elevated lesion of 2 cm in diameter on the anterior wall of the upper gastric body near the esophago-gastric junction; C: Computed tomography revealed a 15-mm submucosal low density area with calcification in the anterior wall of the upper gastric body. No lymph node or distant metastasis was detected; D: Endoscopic ultrasound showed an 11.2 mm × 13.5 mm submucosal tumor derived from the third layer of the gastric wall as a heterogeneous lesion with a mixture of a high echoic lesion, low echoic lesion, and calcification.

Figure 2 Results of histopathological examinations. A: The resected specimen had negative lateral and vertical margins with normal mucosa; B: A pathological examination confirmed that the tumor was intrasubmucosal (the depth of invasion into the submucosal layer was 5000 μm), measured 20 mm × 11 mm × 6 mm, and was a well differentiated adenocarcinoma; C: Dilated gastric glands were found in the submucosal layer. There was no lymphovascular invasion; D: An immunostaining method showed MUC5AC (+) and MUC6 (+), indicating differentiation into the pyloric glands.