Mr. Shen Diagnosed with Gastric Foveolar-Type Carcinoma In Situ, Black Stools Serve as Warning Sign
When Mr. Shen, a 56-year-old male, began experiencing persistent upper abdominal discomfort and intermittent pain two months prior, he initially dismissed it as indigestion. However, when his symptoms worsened over the past two weeks and he noticed black, tarry stools, he decided to seek medical attention. Upon visiting the First Affiliated Hospital of Kunming Medical University in February 2021, a series of diagnostic tests, including endoscopy and histopathological analysis, confirmed a diagnosis of gastric foveolar-type carcinoma in situ.
Initial Presentation and Diagnosis
Mr. Shen reported experiencing upper abdominal discomfort for approximately two months, with recent exacerbation of symptoms and the appearance of black stools. During the outpatient evaluation, a gastroscopy revealed non-atrophic gastritis with a localized, pale, subepithelial elevated lesion measuring approximately 0.6 cm × 0.9 cm on the upper anterior wall of the gastric body. The lesion had a smooth surface and visible dilated vessels. A CT scan showed no signs of local invasion into adjacent structures. Based on these findings, Mr. Shen was admitted for further diagnostic evaluation.
Therapeutic Intervention
Biopsy results suggested the possibility of acid-secreting gland polyps or adenomas. After thorough consultation with Mr. Shen and his family, and considering the localized nature of the lesion, an endoscopic submucosal dissection (ESD) was performed. This minimally invasive procedure was chosen due to Mr. Shen's preference for less invasive treatment and the confined nature of the lesion.
Postoperative histopathological analysis confirmed a diagnosis of gastric foveolar-type carcinoma in situ. The lesion measured 0.4 cm × 0.7 cm and was confined to the mucosal layer without submucosal invasion, vascular embolism, or secondary ulcer formation. The tumor margins were clear, and no residual cancerous tissue was found at the resection borders. Immunohistochemical testing revealed pepsinogen positivity and partial positivity for hydrogen-potassium ATPase, supporting the diagnosis and confirming curative resection under expanded ESD criteria.
Postoperative Recovery and Follow-Up
After a 5-day hospitalization, Mr. Shen's abdominal pain subsided, his bowel movements returned to normal, and no signs of infection or bleeding were observed. He was discharged with instructions for self-monitoring and scheduled follow-ups. Two months post-surgery, an endoscopic follow-up showed complete resolution of gastritis and no signs of tumor recurrence. Mr. Shen expressed satisfaction with his recovery and overall treatment outcome.
Post-Treatment Recommendations
Despite the successful outcome, it is crucial for Mr. Shen to adhere to the following guidelines to ensure long-term health:
1. Regular Monitoring: Monthly follow-up visits are recommended for the first three months. Any recurrence of abdominal pain or abnormal bowel movements should prompt immediate medical evaluation. After three months, if the condition remains stable, annual check-ups may be sufficient.
2. Dietary Adjustments: As his digestive function recovers, Mr. Shen should gradually reintroduce regular meals, focusing on soft, easily digestible foods. Spicy, cold, or otherwise irritating foods should be avoided to prevent gastrointestinal stress.
3. Medication Adherence: Strict compliance with prescribed medications, including omeprazole enteric-coated capsules and sucralfate chewable tablets, is essential. Any changes in dosage or frequency must be discussed with a healthcare provider to avoid complications.
Insights on Early-Stage Gastric Cancer
Gastric carcinoma in situ refers to cancer cells confined to the mucosal or submucosal layers without penetration of the basement membrane or lymph node metastasis. When detected early, the prognosis is typically favorable. In Mr. Shen's case, timely medical intervention allowed for complete endoscopic removal of the lesion without the need for open surgery. Compared to traditional surgical approaches, endoscopic resection offers significant benefits, including reduced trauma, faster recovery, and excellent long-term outcomes—making it a preferred treatment for localized gastric in situ cancers.