Novel combined endoscopic and laparoscopic surgery for advanced T2 gastric cancer: Two case reports

Figure 3 Case 2, minimally invasive endoscopic resection of T2 gastric cancer (endoscopic submucosal dissection and full-thickness resection) and pathology. A and B: Lesion on the greater curvature of the lower gastric body, central ulcer, marginal eminence, about 2.0 cm × 2.5 cm. The resection area was marked 1.5 cm outside the edge of the lesion, and endoscopic submucosal dissection (ESD) was performed along the outside of the marked point. ESD circumferentially peeled to the submucosa, which was thinned and unclear, indicating that the lesion was deeply infiltrated (SM3 or T2); C and D: At 0.5-1.0 cm outside the unclear portion of submucosa, the lesion was resected by ESD and full-thickness resection; E: Mucosal surface of resected lesion (3.8 cm × 4.0 cm); F: The serosa of the resected lesion showed that the area of the resected mucosa (normal mucosa and the mucosa with shallow infiltration) was significantly larger than that of the serosa (location with deep infiltration); G and H: Poorly differentiated adenocarcinoma, containing signet ring cells, infiltrating into the superficial layer of muscularis propria (red box); scale bar, 500 μm; I: Immunohistochemical staining of cytokeratin expression at location of poorly differentiated adenocarcinoma.