Early Gastric Cancer with Remains of Cancer Cells Extensively in the Mucosa by EMR, Report of a Case Kiyoshi Ashida 1 , Yutaro Egashira 1 , Masaya Tanaka 1 1The Second Department of Internal Medicine, Osaka Medical College Keyword: 内視鏡的粘膜切除 , 低分化腺癌 , 癌遺残 , 治療の適応 , 外科手術 pp.1139-1143
Published Date 1996/8/25
DOI https://doi.org/10.11477/mf.1403104282
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 A 50-year-old female was admitted to our hospital with complaints of epigastralgia. Endoscopy revealed early gastric cancer (type Ⅱc), 3 mm in diameter at the anterior wall of the antrum (Fig. 1). Histologically, it was moderately differentiated adenocarcinoma. No invasive cancer was diagnosed by x-ray and endoscopy. Endoscopic mucosal resection (EMR) was performed as a curative therapy. The resected material was 37 × 26 mm in size. Immediately after EMR it was considered that this lesion had been completely resected. However, afterwards, we judged this therapy as non-curative because histologically, poorly differentiated adenocarcinoma had invaded close to the cutends of the EMR specimens (Fig. 6) . A distal gastrectomy was performed. Macroscopically, the remains of cancer cells were not apparent around the EMR induced ulcer. Histologically, cancer cells remained extensively in the lamina propria of the mucosa on the anterior side of the artificial ulcer (Fig. 9 a, b) . This lesion had not been accurately diagnosed before EMR because cancer cells did not invade the epithelium of the mucosa. At present, we don't regard EMR in a patient with an undifferentiated carcinoma as a definitively curative therapy because, as in our patient, it is sometimes difficult to identify accurately the margins of the lesion.

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