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Ⅱc Type Early Gastric Cancer Adjacent to the Pyloric Ring, Report of a Case K. Fukumoto 1 , S. Kato 1 , Y. Mitsuyoshi 1 , M. Takebayashi 1 , K. Sugawara 2 , M. Kato 2 1Dept. of Internal Medicine, Biwako Gastrointestinal Hospital 2Dept. of Surgery, Biwako Gastrointestinal Hospital pp.455-460
Published Date 1976/4/25
DOI https://doi.org/10.11477/mf.1403107144
  • Abstract
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 A woman aged 56 came to our hospital with a chief complaint of dull pain in the right hypochondrium. X-rav revealed two protruding lesions the size of a pea and red bean, respectively, in the neighborhood of the pylorus and another couple of elevations in the duodenum.

 Endoscopy with GTF-SII showed two protrusions each in the lesser curvature side and on the posterior wall. The intervening area on the posterior wall was hemorrhagic. The bleeding spot was recognized by JF-BII as a depression. A IIc lesion was then suspected. Also were seen in the duodenal bulb two smooth-surfaced protrusions of varying size. Minute observation of the surface of the two protrusions in the pylorus suggested their benign nature. On the other hand, when dye scattering method was coemployed, the extent of depression in the pylorus and rough granular changes around it were seen to better advantage and malignancy was suspected. Of 11 pieces of biopsy specimens taken from all these parts, well differentiated carcinoma was recognized only in the depression. Resected specimen showed, corresponding to the endoscopic observations, an irregularshaped depression accompanied with reddening on the posterior wall side in the neighborhood of the pyloric ring along with two elevations there.

 Histologic study showed differentiated tubular carcinoma, 25×7 mm in diameters, with depth degree m, in an area corresponding to the irregular-shaped depression. It was also shown that the protrusion in the lesser curvature side was an adenomatous polyp, and rough granulas on the posterior wall represented intact mucosa left within the Ⅱc area. Protrusions in the duodenal bulb proved to be Brunnerioma.

 The present case illustrates the fact that preoperative diagnosis by endoscopy is becoming more accurate. X-ray diagnosis was protruding lesions in the stomach and duodenal bulb, but a small IIc type cancer did exist in between.


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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