Early gastric cancer located just above Dieulafoy's ulcer, with massive bleeding

Taketsuka, Shojiro; Kasama, Kazunori; Kakihara, Yasuharu; Horie, Kenji; Tagaya, Nobumi; Kojima, Masaru; Maruyama, Keiichi

doi:10.1007/s10120-006-0383-6

Cited by 4 publications

(3 citation statements)

References 9 publications

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“…Taketsuka et al hypothesized that repeated erosions and ulcers in the mucosa could be induced by circulation disturbances in vessels of DL, and active regeneration and dysplasia may further promote the process of carcinogenesis. This hypothesis is in line with the phenomenon that DL was located underneath the cancerous lesion in all reported cases [4]. Nonetheless, the prognosis of patients with gastric cancer concomitant with DL mainly depends on the pathologic stage of the gastric cancer.…”

Section: Discussionsupporting

confidence: 82%

“…PostUnknownIIcOn DieulafoysigsmBenignKishikawa, 2003 [3]1569/MC. Post50 × 40IIaOn Dieulafoytub1smBenignTaketsuka, 2006 [4]1675/MStump4 × 3IIcOn Dieulafoytub1sm0-IIcGurzu, 2013 [5]Advanced Gastric Cancer148/MM.Ant20 × 20IIcOn DieulafoysigmpBenignTaniguchi, 1992256/MC. Less50 × 25IIc + IIaOn Dieulafoytub2mpBenignKishimoto, 2005 [6]3†57/FA.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Mass-like Dieulafoy’s lesion associated with advanced gastric cancer at the antrum of stomach: a case report and literature review

2017

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BackgroundDieulafoy’s lesion, also known as a caliber-persistent artery, is a shallow, small, and rare lesion that occurs along the lesser curvature of proximal stomach. It is rare for a Dieulafoy’s lesion to present as a mass-like lesion that coexists with gastric cancer. To our best knowledge, we report the first case and histopathological pictures of a mass-like Dieulafoy’s lesion coexisting with advanced gastric cancer in the antrum of the stomach.Case presentationA 57-year-old female presented with a 6-month history of intermittent epigastric dull pain and dyspepsia. Subsequent upper gastrointestinal endoscopy revealed a friable mass that was located between the distal antrum and the pyloric ring. Biopsy revealed it to be an intestinal type adenocarcinoma. Subtotal gastrectomy was performed after neoadjuvant chemotherapy. Grossly, a large irregular plaque-like tumor lesion was noted at the anterior wall of the distal antrum and pylorus ring near the lesser curvature, measuring 5.6 × 4.8 × 1.0 cm. Histopathological examination of the resected stomach revealed that the plaque-like lesion largely consisted of numerous abnormally large-caliber and tortuous arteries in the submucosa. The increased fibrosis of the submucosa resulted in the formation of elevated plaque. The intestinal type adenocarcinoma was noted to be largely confined to the mucosa layer, with focal submucosal and muscular propria involvement. The patient was discharged one week after the subtotal gastrectomy, and she was alive and well 17 months after discharge, with no major complications.ConclusionThis is the first case of a mass-like Dieulafoy’s lesion coexisting with advanced gastric cancer at the distal antrum area. This case highlights the possibility of life-threatening gastric bleeding after mucosal resection or biopsy that could be encountered by endoscopists.

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Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Mass-like Dieulafoy’s lesion associated with advanced gastric cancer at the antrum of stomach: a case report and literature review

2017

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“…In addition, in the context of mucosal regeneration in ischemic injury related to vascular malformation, “signet ring cell dripping of early gastric cancer should be considered. According to a case and literature review of Dieulafoy with type IIa gastric cancer, taketsuka S et al [ 9 ] pointed out that the dyscirculation in Dieulafoy blood vessels can cause repeated mucosal regeneration. The recurrent regeneration of vascular mucosa and abnormal hyperplasia of mucosa may be 2 of the factors to promote gastric cancer.…”

Section: Discussionmentioning

confidence: 99%

Dieulafoy disease with gastric MALT lymphoma

et al. 2020

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Rationale: Dieulafoy lesion (DL), a rare cause of gastrointestinal bleeding, is easily covered by blood scab formation on the mucous membrane for its small size, which makes it difficult to be identified under endoscope. In clinical practice, it is also very easy to miss gastric mucosa-associated lymphoid tissue (MALT) lymphoma that exhibits atypical early manifestations under gastroendoscope and is difficult to be diagnosed by routine superficial biopsy. Most patients only experience nonspecific dyspepsia symptoms. Patient concerns: A 68-year-old man suffering from repeated melena for 6 years arrived at our hospital. The patient had undergone gastroscopy and capsule endoscopy at other hospitals for several times and received symptomatic treatment, but his melena still continued to recur. At our hospital, the capsule endoscopy displayed that there existed large hemorrhage in the stomach, after which a gastrointestinal decompression tube was placed, so the bright red blood was drained. Subsequently, a sunken vascular malformation tissue in the anterior wall of the gastric fundus was observed under emergency endoscope. Pulsating blood flow appeared immediately after biopsy, and over-the-scope clip (OTSC) was quickly applied to stop the bleeding. Near the bleeding point, scar-like tissue that was surrounded by interrupted mucosa was discovered, and biopsy was performed at this site. Diagnosis: The diagnosis of DL and gastric MALT were determined by the digestive endoscopy and biopsy pathology. Interventions: With the diagnosis of DL and gastric MALT, the hemorrhagic spot was treated by OTSC. After the patient's condition was stable, anti- Helicobacter pylori treatment was performed. Outcomes: After the corresponding treatment, the 6-month follow-up revealed that the lymphoma was not completely cured, but no further bleeding occurred. There was no bleeding in the epigastric region and the patient was in good condition. Lessons: From endoscopy, it is easy to miss DL. When the hemostatic equipment is fully prepared, biopsy can be performed. After biopsy, pulsatile bleeding is convincing evidence for Dieulafoy disease. OTSC represents an effective and low-risk method for DL and it could replace surgery. Moreover, the mucosa surrounding Dieulafoy disease should be carefully observed to exclude coexisting diseases such as lymphoma or gastric cancer.

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