A Case of Scirrhous Carcinoma of the Stomach Simulating a Submucosal Tumor M. Sakai 1 , T. Miyake 1 , Y. Yamamoto 1 , J. Ariyoshi 1 , S. Kashiwara 2 1Dept. of Gastroenterology, Tenri Hospital 2Dept. of Abdominal Surgery, Tenri Hospital pp.1565-1570
Published Date 1978/11/25
DOI https://doi.org/10.11477/mf.1403107558
  • Abstract
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 A report is made of a gastric cancer that could not be diagnosed by X-ray and endoscopy alone.

 A 72 years old man, a company executive, had consulted his family physician on account of rash on the skin and dull epigastric pain. He was referred to our hospital after he had been found to harbor Borrmann 1 type cancer of the stomach revealed by re-X-ray. Physical and laboratory examinations showed that rash was seen all over the body with a palpable tumor the size of an egg in the abdomen. Besides slight diabetes mellitus, considerable eosinophilia was noticed in the blood. X-ray examination of the stomach showed a protruding lesion with erosions at the tip, extending from the posterior wall of the angle down to the lesser curvature of the antrum. The protrusion was raised at a sharp angle. Endoscopy showed auricle-like reddening around the erosions. The surrounding mucosa looked like normal but the tumor itself was accompanied with bridging folds. By the findings of X-ray and endoscopy alone, it was hard to tell whether this tumor be a submucosal one or epithelial growth. Cancer we had naturally to take into account, Hodgkin's disease because of skin rash, eosinophilic granuloma as was suggested by the changes in the blood and so on.

 We were unable to arrive at an accurate diagnosis until biopsy disclosed undifferentiated carcinoma, which proved to be scirrhus by the histologic examination of the resected specimen.

 Although various ancilliary methods of diagnosis have been improved greatly, we must still endevor to reach such a time when we might be able to diagnose gastric lesions accurately by the usuall examination methods. One of the reasons for the difficulty of diagnosis in this case was that the tumor, developing mostly in the submucosa, grew as a tumor mass sharply circumscribed with the surrounding mucosa.

 Except for the part of erosions, it was covered with normal mucosa. Histologically it was scirrhus, but it would be false to conclude that scirrhus be cancer of Borrmann type 4. Such a conclusion would make the diagnosis of the present case much more difficult.

Copyright © 1978, Igaku-Shoin Ltd. All rights reserved.


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