Early Gastric Cancer Associated with a Gastric Lipoma

A 63-year-old woman was referred to our hospital to undergo endoscopic therapy for a lesion suspected of being early gastric cancer. A biopsy had already been performed. The diagnosis was adenoma with Helicobacter pylori, but cancer could not be ruled out. Esophagogastroduodenoscopic observations revealed a whitish, elevated lesion 20 mm in diameter with 4 large lobules and a central depression in the posterior wall of the lower corpus (Figure 1). Magnifying narrow-band imaging showed an oval or tubular microsurface pattern and a loop microvascular pattern; it appeared to be malignant rather than benign. These narrow-band imaging findings indicated an epithelial lesion, but the lesion thickness led us to doubt submucosal invasion. Although there was no pillow sign, subsequent endoscopic ultrasonographic (EUS) observation revealed a hypoechoic mass in the mucosal layer without submucosal invasion. EUS also revealed a homogeneous hyperechoic mass in the submucosal layer immediately below the gastric tumor, covered completely by the gastric lesion (Figure 2). Results suggest that this submucosal mass was lipoma and that the lipoma influenced the gastric cancer thickness. The subepithelial lesion was not detected on computed tomography. To avoid creating difficulty for endoscopic submucosal dissection (ESD), we did not attempt biopsy or EUSguided fine-needle aspiration of the subepithelial lesion through the gastric cancer.