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infiltrating type of poorly differentiated gastric carcinoma. It is characterized by cancer cell infiltration and proliferation beneath the gastric mucosa with marked stromal fibrosis [1]. The gastric wall is thickened and stiffened due to diffuse in− filtration and proliferation of cancer cells with extensive stromal fibrosis. Endosco− py is useful for assessing the growth pat− tern, but it is very difficult to obtain an appropriate sample with a routine pinch biopsy. However, after utilizing argon plasma coagulation (APC) to remove the superficial gastric epithelium and cauter− ize the denuded surface, we were easily able to confirm the diagnosis of scirrhous gastric carcinoma with pinch biopsy. A 79−year−old woman attended a clinic because of upper abdominal discomfort. Gastrointestinal endoscopy strongly sug− gested the presence of advanced gastric cancer, but no cancer cells were found in routine biopsy specimens. The patient was referred to our hospital for definitive diagnosis and further treatment. At gas− trointestinal endoscopy, the stomach was very hard and could not be distended with air; it was covered with roughened mucosa that was red and edematous, but no erosions or ulcerations were seen (l" Fig. 1). Biopsy was done again, but a histopathological diagnosis was not ob− tained. To obtain a definitive diagnosis, biopsy after APC treatment was utilized [2]. APC treatment included 50 W soft−mode co− agulation and 0.5 L/min argon gas (ICC200; Erbe Co., Tübingen, Germany). The first biopsy after APC treatment yiel− ded a definite histopathological diagno− sis; cancer cells were observed beneath the APC−burned area in the biopsied sam− ple (l" Fig. 2). The cancer cells, clustered together, were small−sized, atypical cells that contained PAS−positive material in their cytoplasm. On the basis of these findings, a definite histopathological di− agnosis of poorly differentiated adenocar− cinoma was made.

Utility of endoscopic pinch biopsy after argon plasma coagulation treatment for diagnosing scirrhous gastric carcinoma