It may be difficult to distinguish depressed-type gastric cancer from benign gastric ulcer. We report a case of early gastric cancer distinguished from benign gastric ulcer by magnifying endoscopy with narrow band imaging. A 66-year-old man was admitted to our hospital for further examination of gastric ulcerated lesions that had been incidentally identified in an esophagogastroduodenoscopy (EGD). Endoscopy revealed two gastric ulcerated lesions. One was an excavated lesion, measuring 20mm in

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... ameter at the posterior wall of the gastric angle of the stomach and the other was a depressed lesion, measuring 5mm in diameter at the anterior wall of the gastric angle of the stomach. Although multiple biopsy specimens were taken in the first and second EGD in our hospital, these lesions remained undiagnosed. In the third EGD, a depressed area with irregular microvascular and mucosal patterns could be observed at the margins of ulceration by magnifying endoscopy with narrow band imaging. Biopsy specimens taken from the depressed area showed group 5. In the natural course of cancer development, ulceration in early gastric cancer repeats healing and relapsing phases, the so called "malignant cycle"; therefore, we should observe the margins of ulceration carefully, and perform biopsy from the depressed area with irregular microvascular and mucosal patterns, understood as the "malignant cycle". It is also important to perform biopsy again until it provides a definite diagnosis if endoscopic images show that the lesion has a possibility of being gastric cancer.