Early Gastric Cancer in which the Diagnosis was Difficult Due to the Intramucosal Extension of the Lesion, Report of a Case Ryuji Nagahama 1 , Hirotaka Nakashima 1 , Goro Yamaki 1 , Yasuo Ohkura 2 1Department of Gastroenterology, Tokyo Metropolitan Cancer Detection Center 2Department of Clinical Pathology, Saitama Cancer Center Keyword: 早期胃癌 , 進展範囲 , Ⅱb様進展 , 印環細胞癌 , 粘膜内進展様式 pp.1295-1302
Published Date 2001/9/25
DOI https://doi.org/10.11477/mf.1403103326
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 In July, 1996, a 54-year-old male patient was referred to our center for mass screening. A radiolucent lesion was diagnosed in the antrum. Endoscopical examination showed multiple erosions in the antrum for which the patient had been followed up endoscopically each year until 2000. In June of the same year, the follow-up by endoscopy showed a discoloured area in the posterior wall of the middle gastric body. Histological diagnosis confirmed a signet-ring cell carcinoma. Double contrast study showed a barium fleck and nodular mucosa in the posterior wall of the middle gastric body. The endoscopical examination showed a discoloured area and irregular mucosa in the same area. Indigo dye spray showed that the contrast surrounded the lesion. This kind of lesion is diagnosed as an undifferentiated type of early gastric cancer for which the patient underwent a subtotal gastrectomy. The histological diagnosis was 0 IIc, the size of the lesion was 9.0×7.5 cm, and the depth of invasion was SM2. The histological type was a signet-ring cell carcinoma, INFγ, ly2, v0, n0. The histological examination showed that the cancer was neither found in the surface of the mucosa nor did it invade the muscularis mucosae but was concentrated in the middle of the mucosal layer. Therefore it was difficult to diagnose the extension of the lesion before surgery.

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