Undiagnosed Borrmann type Ⅱ gastric cancer due to necrosis and regenerative epithelium

Endoscopic biopsy is essential to the proper diagnosis and treatment of gastric cancer.Unfortunately,the results of endoscopic biopsy are not always the same as what is expected based on gross endoscopic findings.The results of endoscopic biopsy can be negative for malignancy in Borrmann typeⅣadvanced gastric cancer(AGCa)or gastric lymphoma.However,in the case of typeⅡAGCa,repeated biopsies negative for malignancy have not been reported.A 49-year-old male patient underwent esophagogastroduodenoscopy three times due to large gastric ulcer suspected to be Borrmann typeⅡcancer.However,three repeat endoscopic biopsies with multiple specimens showed necrosis and superficial regenerative epithelium without malignant findings.The patient underwent laparoscopic distal gastrectomy with D2 lymph node dissection.The surgical specimen revealed that the mucosal layer was completely replaced with regenerative epithelium without cancer cells.