Case Report
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World J Gastroenterol. Jul 28, 2014; 20(28): 9621-9625
Published online Jul 28, 2014. doi: 10.3748/wjg.v20.i28.9621
Undiagnosed Borrmann type II gastric cancer due to necrosis and regenerative epithelium
Joon Hur, Jae Hyuck Chang, Byung Kee Kim, Hoon Young Ko, Jong Hwan Lee, Soo Jeong Kim, Mi Ae Song, Tae Ho Kim, Chang Whan Kim, Sok Won Han
Joon Hur, Jae Hyuck Chang, Hoon Young Ko, Jong Hwan Lee, Soo Jeong Kim, Mi Ae Song, Tae Ho Kim, Chang Whan Kim, Sok Won Han, Division of Gastroenterology, Department of Internal Medicine, Bucheon St. Mary’s Hospital, The Catholic University of Korea, College of Medicine, Bucheon 420-717, South Korea
Byung Kee Kim, Department of Clinical Pathology, Bucheon St. Mary’s Hospital, The Catholic University of Korea, College of Medicine, Bucheon 420-717, South Korea
Author contributions: Hur J and Chang JH designed and organized the report; Ko HY, Lee JH, Kim SJ, Song MA, Kim TH, Kim CW and Han SW contributed to the discussion and reviewed the manuscript; and Kim BK performed the pathological examinations and reconstruction mapping.
Correspondence to: Jae Hyuck Chang, MD, PhD, Division of Gastroenterology, Department of Internal Medicine, Bucheon St. Mary’s Hospital, The Catholic University of Korea, College of Medicine, Bucheon 420-717, South Korea. wwjjaang@catholic.ac.kr
Telephone: +82-32-3402227 Fax: +82-32-3402255
Received: January 13, 2014
Revised: January 29, 2014
Accepted: April 1, 2014
Published online: July 28, 2014
Abstract

Endoscopic biopsy is essential to the proper diagnosis and treatment of gastric cancer. Unfortunately, the results of endoscopic biopsy are not always the same as what is expected based on gross endoscopic findings. The results of endoscopic biopsy can be negative for malignancy in Borrmann type IV advanced gastric cancer (AGCa) or gastric lymphoma. However, in the case of type II AGCa, repeated biopsies negative for malignancy have not been reported. A 49-year-old male patient underwent esophagogastroduodenoscopy three times due to large gastric ulcer suspected to be Borrmann type II cancer. However, three repeat endoscopic biopsies with multiple specimens showed necrosis and superficial regenerative epithelium without malignant findings. The patient underwent laparoscopic distal gastrectomy with D2 lymph node dissection. The surgical specimen revealed that the mucosal layer was completely replaced with regenerative epithelium without cancer cells.

Keywords: Endoscopy, Biopsy, Stomach neoplasm, Stomach ulcer, Regeneration

Core tip: We present a case of Borrmann type II gastric cancer undiagnosed by three repeat endoscopic biopsies with multiple specimens due to necrosis and superficial regenerative epithelium. When endoscopic and ultrasonography findings highly suggest malignancy, operation or surgical biopsy should be considered.