A 49-year-old male was admitted to our hospital with upper gastrointestinal bleeding.
Endoscopic examination revealed a depressed lesion with an exposed vessel on the upper body of the stomach. Our diagnosis was Dieulafoy's ulcer, and endoscopic hemostasis was successfully performed by clipping. About 50 days later, a follow-up endoscopy revealed abnormal mucous membrane with redness near the ulcer scar. Histological examination of the biopsy specimen showed moderately differentiated adenocarcinoma. Total gastrectomy was carried out. Macroscopically, a IIc lesion was noticed on the lesser curvature of upper gastric body, and its diameter was 65×45mm. Tumor cells were limited mainly in the mucosal layer. We were not able to find the ruptured vessel, but the internal mucosa was thickened, and a winding vessel was observed in the submucosal layer. Gastric cancer associated with Dieulafoy's vascular malformation is extremely rare, and only 16 cases, including ours, have been reported in Japan. Our case with early gastric carcinoma detected following a bleeding ulcer suggests the importance of careful endoscopic observation after hemostasis.