Demonstrates the importance of EUS-guided tissue acquisition in discordant gastric adenocarcinoma cases, suggesting improved diagnosis.
A 65-year-old man presented with gastric outlet obstruction and marked neutrophil-predominant leukocytosis. Gastroscopy showed an infiltrative antral lesion, and superficial biopsy revealed moderately differentiated adenocarcinoma. However, contrast-enhanced computed tomography and endoscopic ultrasound demonstrated a bulky hepatogastric mass that was disproportionate to the mucosal findings. Transgastric EUS-guided tissue acquisition revealed malignant cells with sarcomatoid morphology and immunohistochemical findings supporting gastric adenocarcinoma with sarcomatoid differentiation. This case highlights the value of early EUS-guided deep tissue acquisition when mucosal biopsy and cross-sectional imaging are discordant.
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Ma et al. (2026) studied this question.
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