Three synchronous lesions with different historical types diagnosed by endoscopic submucosal dissection in one patient

A 69-year-old man underwent gastroscopy owing to intermittent abdominal distension for over 4 months. The gastroscopy revealed two distinct lesions in the lower stomach body, which was highly atrophied (O-3) [1], and the background mucosa was infected with Helicobacter pylori. Lesion 1, labeled as 0-Is + IIa [2], measured 40 × 20 mm and had a nodular mixed-type appearance on the posterior wall of the stomach body ([Fig. 1 a, b]). Lesion 2, labeled as 0-IIb, measured 15 × 10 mm and was adjacent to lesion 1 on the oral side ([Fig. 2 a]). Biopsy pathology of both lesions showed atypical cells.