What happened, in summary

A 58-year-old man with upper-abdominal pain was found to have more than one gastric tumor. One was a small, submucosal-looking lesion in the upper stomach. Biopsy showed atypical cells resembling fundic gland cells, raising suspicion for gastric adenocarcinoma of fundic gland type. Imaging did not show nodal or distant metastases.

The lesion was removed in one piece by endoscopic submucosal dissection. Pathology confirmed a 7-by-4-mm adenocarcinoma of fundic gland type that extended only a short distance into the submucosa, with negative resection margins and no lymphatic or vascular invasion described. The surrounding stomach also contained diffuse heterotopic gastric glands.

Because the same patient had a separate, more advanced antral gastric cancer and concern for additional cancers in the remaining stomach, he later underwent total gastrectomy. Examination of the gastrectomy specimen found no residual fundic-gland-type cancer near the prior endoscopic resection scar.