A Case of Well Differentiated Adenocarcinoma of Borrmann Type 4 advanced Gastric Cancer

Shin-ichi Nakanuma, Shinichi Kinami, Katsunobu Oyama, Hiroshi Funaki, Hideto Fujita, Itasu Ninomiya, Sachio Fushida, Takashi Fujimura, Masato Kayahara and Tetsuo Ota

Gastroenterological Surgery, Department of Oncology, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University

A 58-year-old woman admitted for multiple myeloma and treated with chemotherapy was found in Abdominal computed tomography (CT) to have showed wall thickening in the upper gastric body, together with multiple cystic lesions at the same site. Barium enema studies showed wall hardening with unclear margins in the upper gastric body and fundus. Endoscopy showed a low protruding nodular lesion with unclear margins on the posterior wall of the upper gastric body. Endoscopic biopsy indicated well-differentiated adenocarcinoma, yielding A diagnosis of Borrmann type 4 advanced gastric cancer with diffuse heterotopic multiple cysts. The tumor was found to have spread from the upper gastric body to the fundus, with serosal penetration and peritoneal dissemination. The Pathological diagnosis was well-differentiated adenocarcinoma invading all layers diffusely forming large glandular cavities and scirrhous changes. Immunohistochemical staining showed tumor cells to be positive for MUC5AC and slightly positive for MUC6 but negative for MUC2. Based on these findings, the definitive diagnosis was gastric phenotype. Borrmann type 4 advanced gastric cancer consisting of well-differentiated adenocarcinoma alone is rare. Our case suggested two characteristic features: large carcinomatous glandular cavities such as gastric cysts related to well-differentiated adenocarcinoma of Borrmann type 4 advanced gastric cancer, and an endoscopic picture of a low protruding nodular lesion with unclear margins related to differentiated carcinoma with a gastric phenotype.

Key words
well differentiated adenocarcinoma, Borrmann type 4, gastric phenotype

Reprint requests
Shin-ichi Nakanuma Gastroenterological Surgery, Department of Oncology, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University
13-1 Takara-machi, Kanazawa, 920-8641 JAPAN

Accepted
January 28, 2009

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