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A Cace of Type Ⅱc Early Gastric Cancer simulating Elevated Ulcer Scar S. Ito 1 , T. Murakami 1 , M. Tanaka 2 , S. Kishi 3 , G. Akagi 4 1Dept. of Internal Medicine, National Zentsuji Hospital 2Dept. of Surgery, National Zentsuji Hospital 31st Dept. of Internal Medicine, School of Medicine Tokushima University 42nd Dept. of Pathology, School of Medicine Tokushima University pp.209-213
Published Date 1976/2/25
DOI https://doi.org/10.11477/mf.1403107096
  • Abstract
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 Case: a 45-year-old man. Chief complaint: epigastralgia.

 Upright, barium-filled X-ray picture revealed widened angle along with irregular contours of the stomach. In double contrast picture was seen mucosal convergency with an oval tumor-like shadow in the center. Pictures with GTF-A showed on tha posterior wall side near the lesser curvature of the angle a hemispheric small protrusion with marked reddening, surrounded by groove-like excavations. The mucosal folds ceased in their vicinity and their tips showed erosions with shapes as if worm-eaten. Resected stomach revealed at the angle a small hemispheric protrusion, about 7 mm in diameter, toward which the mucosal folds seemed to converge. Their tips tapered around the lesion, forming nests of Ⅱc-like shallow excavations encircling the elevation. Histologic study of a section through the center of the elevation showed a plateau-like protrusion with slight constriction around the base. The protrusion consisted chiefly of hyperplastic epitherium of the fovelolae, and there was nothing to suggest malignancy. Circular depressions around the protrusion showed well-differentiated tubular adenocarcinoma localized within the mucosal layer.

 The present case looked morphologically similar to what Sano classified as Ⅱa+Ⅱc belonging to fringe depression type, but the central protrusion was not Ⅱa but regenerative, hyperplastic nests, constituting the so-called “sanctuary area” within Ⅱc. The present case is thus considered to belong to Ⅱc type early cancer. Ulcer scar has been regarded solely as the terminal picture of the depressed lesion, and hardly any effort has been made in the study of ulcer scar with central elevation. Such an ulcer scar, however, is naturally of benign nature to be strictly differentiated from such a case as was described here. Its recognition seems to be clinically very important.


Copyright © 1976, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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