LAUSR

A 67-year-old man was diagnosed as having an advanced pharyngeal cancer. The patient underwent esophagogastroduodenoscopy (EGD) for a screening of overlap malignancies, which revealed gastric protruding lesions. He was referred to our institution for further examination. EGD disclosed thickened gastric folds with multiple submucosal tumor-like protrusions in the greater curvature of the gastric corpus (Fig. 1a). In addition, an irregularly shaped depressed area was found in the greater curvature of the lower corpus (Fig. 1b). Magnifying endoscopy with narrow band imaging revealed irregular microsurface and microvessel patterns in the center of the depressed area (Fig. 1c). Biopsy from the depressed area showed moderately differentiated adenocarcinoma. Endoscopic ultrasound (EUS) showed low-echoic cystic lesions in the submucosal layer (Fig. 1d). After chemo-radiotherapy for pharyngeal cancer, he underwent a total gastrectomy (Fig. 2a). Histological examination of the resected specimen revealed cystic lesions in the submucosa of lower corpus, which contained moderately differentiated adenocarcinoma (Fig. 2b, c). Multiple cystic lesions without neoplasia were also found in the gastric corpus (Fig. 2d). Background gastric mucosa showed Helicobacter pyloriassociated chronic atrophic gastritis with intestinal metaplasia. We, thus, diagnosed this case as diffuse cystic malformation (DCM) accompanied by early gastric cancer.