Advanced Gastric Cancer without Preoperative Histologic Confirmation, Report of a Case Ken-ichi Tarumi 1 , Mitsuo Iida 1 , Hideki Koga 1 1Division of Gastroenterology, Department of Medicine, Kawasaki Medical School Keyword: 膠様腺癌 , 粘膜下腫瘍様胃癌 , 生検 pp.1541-1547
Published Date 1999/11/25
DOI https://doi.org/10.11477/mf.1403102873
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 A 49-year-old man underwent upper endoscopy at a local clinic in 1991 because of epigastric pain. A diagnosis of gastric ulcer was made and he was treated with H2 receptor antagonist and cytoprotective agents. Repeated endoscopic examinations were performed during the next six years, with no histologic finding of carcinoma ever being found in biopsy specimens. In July 1997, he was admitted to our hospital with severe epigastric pain. Radiologic and endoscopic examinations of the stomach disclosed a submucosal tumor accompanied by a huge ulcer on the posterior wall of the antrum. Only a part of the margin of the ulcer was irregular. Endoscopic ultrasonography revealed a highechoic heterogeneous mass invading the fourth layer. Considering every finding of these imagings, advanced gastric cancer mimicking a submucosal tumor was suggested. However, carcinoma could not be confirmed by repeated histologic examinations of the biopsy specimens. Bacause another early cancer was detected on the anterior wall of the antrum, a diatal gastrectomy was performed. Macroscopic examination of the resected specimen showed an ulcerating tumor measuring 37×33 mm in size on the posterior wall and a depressed lesion measuring 20×18 mm in size on the anterior wall. Microscopic examination of the former lesion confirmed a mucinous adenocarcinoma infiltrating the serosa. Therefore, such case should be systematically evaluated by detailed clinical and careful histological examinations.

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