What happened, in summary

A 61-year-old man with no symptoms had routine gastroscopy that found a small reddish lesion with a shallow central depression in the lower stomach. Initial biopsy showed inflammation, erosion, intestinal metaplasia and a small number of atypical cells rather than a definite cancer. Magnifying endoscopy and ultrasound nevertheless raised strong concern for an early gastric malignancy confined to the stomach lining.

He underwent diagnostic endoscopic submucosal dissection. Pathology showed an 8 x 7 mm moderately to poorly differentiated tubular adenocarcinoma confined to the mucosa, with no lymphovascular invasion. Testing of the tumor was positive for Epstein-Barr virus by EBER in situ hybridization, identifying it as EBV-associated gastric cancer. The horizontal margin was positive, while the deep margin was negative.

He continued endoscopic surveillance. Six months after the resection, gastroscopy showed a scar at the treatment site and no visible signs of recurrence.