White Globe Appearance–Like Findings Indicating Intralymphatic Cancer Involvement Beneath the Epithelium in Gastric Cancer

Q: What endoscopic finding suggested intralymphatic cancer involvement in this case?

Scattered tiny white dots (<1 mm) outside the superficial demarcation line, which under magnifying narrow-band imaging appeared as round white spherical structures with microvessels crossing them (WGA-like features).

Q: How did pathology explain the WGA-like endoscopic appearance?

The resected specimen showed carcinoma with significant lymphatic invasion and lateral spread along lymphatic vessels within the submucosa, with retrograde penetration toward the mucosal lamina propria, reaching just beneath the epithelium.

Q: How was the patient diagnosed before surgery?

Clinical diagnosis was based on endoscopy, biopsy, and contrast-enhanced CT, classifying the lesion as M, post, 0-I, cT1, cN0, cM0, and cStage I.

Sep 21, 2026

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Early gastric carcinoma can show distinctive endoscopic white globe appearances (WGAs), typically in marginal zones, but this case documents WGA-like findings beyond the superficial demarcation line. A 75-year-old woman underwent EGD for reflux, revealing a 25-mm elevated posterior-wall lesion and scattered <1-mm white dots on the oral side of the cancer. Magnifying endoscopy with narrow-band imaging demonstrated round white spherical structures with microvessels crossing them. Histopathology of the resected specimen confirmed intralymphatic cancer extending laterally within submucosa with retrograde penetration toward the mucosal lamina propria, reaching just beneath the epithelium and explaining the WGA features.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages5

Reading Time13 min

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Introduction

Case Report

Wiley Case Reports in Gastrointestinal Medicine Volume 2024, Article ID 8504987, 5 pages [https://doi.org/10.1155/2024/8504987](https://doi.org/10.1155/2024/8504987) Case Report White Globe Appearance–Like Findings Indicating Intralymphatic Cancer Involvement Beneath the Epithelium in Gastric Cancer Hiroki Maruyama , 1 Taku Yamagata , 1 Yoshihide Kanno , 1 Takeshi Shimizu 1 , Takuho Itasaka , 1 Fumiyoshi Fujishima ,2 Takashi Sawai ,3 and Kei Ito 1 1 Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan 2 Department of Pathology, Tohoku University Hospital, Miyagi, Japan 3 Department of Pathology, Sendai City Medical Center, Miyagi, Japan Correspondence should be addressed to Hiroki Maruyama; [h.maruyama25@gmail.com](h.maruyama25@gmail.com) Received 3 July 2024; Accepted 18 September 2024 Academic Editor: Yoshiro Kawahara Copyright © 2024 Hiroki Maruyama et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. A 75-year-old female was diagnosed with a type 0-I, moderately diferentiated, early gastric carcinoma on the posterior wall of the middle gastric body during esophagogastroduodenoscopy (EGD) . Several small whitish structures, referred to as white globe appearances (WGAs), were noted on the oral side outside the demarcation line of the cancerous protrusion. Although this area was fat without cancerous mucosal changes on the surface, subepithelial cancer extension was suspected. Te histopathology of the resected specimen revealed that the carcinoma with submucosal invasion had signifcant lymphatic invasion with submucosal lateral extent along lymphatic vessels. In some areas, the carcinoma within the lymphatic vessels regressed from the submucosal layer towards the mucosal lamina propria, penetrating the muscularis mucosas. Te intralymphatic carcinoma reaching just beneath the epithelium was considered to manifest WGA features during endoscopy. Keywords: early gastric cancer; lateral spread; lymphatic invasion; magnifying endoscopy; narrow-band imaging 1. Introduction Te usefulness of endoscopic fndings of white globe appearances (WGAs) in magnifying endoscopy for diagnosing early gastric cancer has been reported [1, 2] . WGAs are often seen in the marginal area of gastric cancers. However, in the present case, WGA-like fndings were found outside the superfcial demarcation line of an early-stage gastric cancer. Pathological evaluation of a surgically resected specimen revealed that the tumor nests in lymphatic vessels laterally extended within the submucosal layer with retrograde penetration toward the mucosal lamina propria. Te intralymphatic carcinoma reaching just beneath the epithelium was recognized as WGA-like fndings during endoscopy, manifesting small white spherical structures. 2. Case Report A 75-year-old woman, without signifcant complications or past medical history, was referred to our hospital due to complaints of acid refux. No proton pump inhibitor or potassium-competitive acid blocker was taken. Esophagogastroduodenoscopy (EGD) revealed a 25-mm, fainterythematous lesion on the posterior wall of the middle gastric body with background atrophy classifed as Kimura–Takemoto Classifcation O-III. Te lesion was slightly frm and grossly elevated and had a depressed area at its center (Figure 1(a)) . Te edge of the elevating lesion is highlighted with a blue dotted line. Magnifying endoscopy with narrow-band imaging (M-NBI) for the margins of the depression showed indistinct glandular duct structures and 2 Case Reports in Gastrointestinal Medicine (a) (b) (c) (d) Figure 1: EGD images: (a) white light imaging revealing a 25-mm, elevated, slightly reddish lesion on the posterior wall of the gastric middle body. Te edge of the elevating lesion is highlighted with a blue dotted line; (b) magn

FAQs

What endoscopic finding suggested intralymphatic cancer involvement in this case?

Scattered tiny white dots (<1 mm) outside the superficial demarcation line, which under magnifying narrow-band imaging appeared as round white spherical structures with microvessels crossing them (WGA-like features).

How did pathology explain the WGA-like endoscopic appearance?

The resected specimen showed carcinoma with significant lymphatic invasion and lateral spread along lymphatic vessels within the submucosa, with retrograde penetration toward the mucosal lamina propria, reaching just beneath the epithelium.

How was the patient diagnosed before surgery?

Clinical diagnosis was based on endoscopy, biopsy, and contrast-enhanced CT, classifying the lesion as M, post, 0-I, cT1, cN0, cM0, and cStage I.

Sep 21, 2026

Upload by Sage