Seven synchronous early gastric cancer with 28 lymph nodes metastasis

Figure 1 Endoscopic and histologic findings. Multiple early gastric cancer lesions were as follow: A: Raised lesion on the posterior wall of the proximal antrum; B: Erythematous depressive lesion; C: Depressed lesion on the posterior wall of the low body; D: Ill demarcated flat lesion on the anterior wall of the proximal antrum; E, F: Ill demarcated depressed lesion on the anterior wall of the low body (E), on the anterior wall of the mid body (F); G: Ill demarcated flat lesion on the lesser curvature of mid body; H: Adenocarcinoma in lesion B showed invasion into 1/3 of the submucosal layer (arrow) (× 40); I: Lymphatic invasion magnified in quadrangle in H (× 100).

Figure 2 Gross specimen. Three lesions (D-F) are located on the anterior wall, and the other three lesions (A-C) are on the posterior wall. One lesion (G) shows flat early gastric cancer type IIb configuration and is centered at the body, lesser curvature.

Figure 3 Histopathlogical findings. A-G: Adenocarcinoma, poorly differentiated in each early gastric cancer lesions in Figure 1 (× 40); H: Lymph node metastasis after gastrectomy (× 40); I: Signet ring cell type of biopsy specimen in esophagogastroduodenoscopy (× 100).