Two cases of advanced gastric carcinoma mimicking a malignant gastrointestinal stromal tumor

A Rare Variant of Gastric Adenocarcinoma Presenting as a Symptomatic Early-Stage Submucosal Tumor in the Gastric Antral Primary

Gastric adenocarcinomas are a well-known malignancy, with the vast majority presenting as primary mucosal invasions. However, a rare form of this cancer presents from the submucosal layer and mimics submucosal tumors (SMTs). This variant of gastric adenocarcinoma is not only rare, but it is also frequently misdiagnosed as other conditions such as gastrointestinal stromal tumors, lymphoma, or sarcoma. This case report describes a unique case of early gastric adenocarcinoma that presented as a submucosal tumor without invasion into the muscularis propria or primary involvement from the gastric mucosa. Additionally, this raises an important clinical question of whether this variant of gastric adenocarcinoma behaves differently from mucosal-origin cancers in terms of invasion and metastasis. This case highlights the diagnostic challenges and the importance of early detection and accurate diagnosis of this rare presentation of gastric adenocarcinoma. This case also provides valuable insights into the clinical variability of submucosal gastric adenocarcinomas and the need for further research to optimize its management and improve patient outcomes.

Concomitant stromal tumor and early cancer of the stomach: What should be done?

Concomitant gastric stromal tumor (GST) and gastric cancer (GC) is uncommon; even more uncommon is a concomitant GST and early stage GC (EGC). Tumor resection by endoscopic submucosal dissection (ESD) for concomitant GST and EGC has not been reported. We sought to define the clinical importance of detection of concomitant GST and EGC during the first esophagogastroduodenoscopy (EGD), and compare the clinical outcomes of ESD versus radical surgery for the treatment of concomitant GST and EGC. Our investigation was a retrospective cohort study. Patients with concomitant GST and EGC who underwent ESD or radical surgery were enrolled at the university-affiliated hospital from January 2005 to January 2015. The detection rate of concomitant GST and EGC during the first EGD was 3/25 (12%). Among 25 patients, 14 underwent ESD and 11 underwent surgery. Mean operation time and hospital stay were significantly shorter in the ESD group than the surgery group. There were no significant differences in terms of rates of en bloc resection, complete resection, and early complications. Late complications were more common in the surgery group than in the ESD group. The median follow-up duration was 58.9 months. Three- or 5-year overall survival rates were 100% for both groups and no patient died of EGC and GST. There was no local recurrence in the 2 groups; however, 3 metachronous EGC lesions were found during the follow-up period in the ESD group as follows: the simultaneous occurrence of GST and EGC was uncommon; the detection rate of concomitant GST and EGC was very low at the first EGD; and ESD appeared to be a safe, efficient, and popular treatment option for concomitant GST and EGC, that met the ESD absolute indication, and the outcomes were comparable to those achieved with surgery.