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Abstract: Mr. Shen, 56 years old, came to the clinic because of epigastric discomfort and paroxysmal pain 2 months ago, which worsened in the last 2 weeks with black stool.
Basic information】Male, 56 years old
Disease Type】Gastric fundic glandular carcinoma in situ
Hospital】The First Affiliated Hospital of Kunming Medical University
Date of Consultation】February 2021
Treatment plan】Surgical treatment (transendoscopic submucosal dissection) + medication (omeprazole enteric capsules, thioglycollate chewable tablets)
Treatment period】5 days of inpatient treatment, 2 months of follow-up
Treatment effect] The patient recovered well, gastritis disappeared, and there is no sign of tumor recurrence for the time being.
I. Initial consultation
Mr. Shen came to our department and reported that he had symptoms of upper abdominal discomfort about 2 months ago, manifesting as paroxysmal pain, and the symptoms had worsened significantly in the past 2 weeks.
The gastroscopy showed a non-atrophic gastritis with a limited discoloration-like submucosal elevated lesion of about 0.6 cm×0.9 cm in size on the upper anterior wall of the gastric body, with a smooth surface and visible dilated blood vessels, and a CT examination showed no signs of local invasion of adjacent structures. Based on Mr. Shen’s medical history and gastroscopic findings, he was admitted to the hospital for further diagnosis.
(CT: no signs of local invasion of adjacent structures)
II. Treatment
After the gastroscopic biopsy, Mr. Shen’s gastroscopic biopsy suggested the possibility of acid-filled polyp or adenoma.
After perfecting the preoperative examination and excluding the contraindication to surgery, endoscopic submucosal dissection was performed. The postoperative pathological diagnosis: adenoid carcinoma in situ of gastric fundus, the main cellular component was the main cell, the lesion area was 0.4cm×0.7cm, the cancer tissue was confined to the mucosal layer but did not invade the submucosal layer, no cancer thrombus was seen in the vasculature, no secondary ulcer was formed, and no tumor tissue remained in the lateral and basal cut edges of the specimen. Postoperative exploration revealed that the gastric mucosal tissue around the lesion still showed mild chronic non-atrophic gastritis, so Mr. Shen was given appropriate amount of omeprazole enteric capsules + thioglycollate chewable tablets for postoperative treatment. Postoperative immunohistochemical examination showed that Mr. Shen’s tumor cells expressed positive pepsinogen and individual positive hydrogen-potassium ATPase, and the pathological diagnosis met the criteria of curative resection for expanded indications of endoscopic submucosal dissection, therefore, after 5 days of hospitalization, Mr. Shen was instructed to discharge himself for monitoring his condition and regular follow-up.
III. Treatment effect
After 5 days of hospitalization, Mr. Shen’s abdominal pain basically disappeared, the color of stool returned to normal, and there was no blood leakage or infection at the incision, and his vital signs were stable. After 2 months of follow-up after discharge, endoscopic review showed that Mr. Shen recovered well, gastritis disappeared completely, and there was no sign of tumor recurrence for the time being.
IV. Notes
I am glad that Mr. Shen has recovered well, but I still need to advise him to pay attention to the following points after surgery.
1. Within 3 months after discharge from hospital, try to have a review once a month, and if abdominal pain occurs again during the follow-up period, you should immediately consult a doctor for a review to avoid delaying the diagnosis and treatment of the disease.
2, after the basic recovery of Mr. Shen’s digestive function, and then gradually return to a normal diet, it is recommended to soft, easy to digest food, avoid eating cold, spicy and other stimulating food to add burden to the digestive tract;.
3, Mr. Shen should strictly follow the doctor’s prescription, do not increase or decrease the dose or frequency of medication, not to change or discontinue the medication without authorization, and communicate with the doctor in a timely manner if adverse drug reactions occur.
V. Personal insight
Gastric carcinoma in situ means that the cancer cells only infiltrate into the mucosal layer or submucosal layer in a limited way and have not yet broken through the basement membrane, and there is no lymphatic metastasis, which usually has a better prognosis if treated in time.
In this case, since Mr. Shen was diagnosed in time after symptoms appeared, the lesion was still confined to the mucosal layer at the time of treatment, which is an early stage gastric cancer, so the lesion could be completely removed through endoscopy and the prognosis is good. In Mr. Shen’s case, compared with traditional surgery, endoscopic resection of limited lesions has the advantages of less surgical trauma and faster postoperative recovery, so it is a more recommended surgical method for treating gastric carcinoma in situ.