Large, White Globe Appearance–Like Endoscopic Findings: Stomach Lymphatic Invasion Distant From Advanced Gastric Cancer

A 62-year-old man presented with neurological symptoms, and head computed tomography revealed multiple brain metastases. Subsequent evaluation identified a 30-mm Type 2 ulcerative lesion in the lower gastric body, diagnosed as moderately differentiated tubular adenocarcinoma. In addition, numerous small, patchy white lesions with a large "white globe appearance (WGA)-like" appearance were observed endoscopically throughout the stomach. Histological analysis confirmed lymphatic invasion of adenocarcinoma in these areas. These findings suggest that a large WGA-like appearance may reflect lymphatic dissemination and could serve as endoscopic markers for evaluating tumor invasion depth and metastatic potential in gastric cancer.