What happened, in summary

A woman in her 50s underwent routine upper gastrointestinal screening even though she had no digestive symptoms. Testing and endoscopic findings supported that she had not been infected with Helicobacter pylori and had no gastric mucosal atrophy. Endoscopy found a small whitish, flat elevated lesion in the lower stomach.

The lesion did not have the typical endoscopic appearance of gastric cancer, but biopsy showed signet-ring cell carcinoma. Further endoscopy and ultrasound found no evidence that the tumor had invaded beneath the mucosa, and chest and abdominal CT showed no metastasis. She therefore underwent endoscopic submucosal dissection.

The removed tumor measured 10 x 6 mm. Pathology confirmed signet-ring cell carcinoma limited to a superficial portion of the stomach lining, with no lymphovascular invasion. The endoscopic resection was considered complete. She then continued periodic endoscopic and CT surveillance. During the following 2 years, no local recurrence or metastatic disease was detected. The case highlights an unusual small signet-ring gastric cancer arising in an H. pylori-uninfected stomach and presenting as a subtle elevated lesion during screening.