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A Case of Giant Multiple Gastric Ulcer Simulating Inflammatory Pseudotumor of the Stomach P. H. Chen 1 , K. Y. Hsu 2 , T. P. Chiang 2 , T. Y. Chen 3 , T. Takemoto 4 1Department of Internal Medicine, Taipei Municipal Jen-Ai Hosp. 2Department of Surgery, Taipei Municipal Jen-Ai Hosp. 3Department of Pathology, Taipei Medical College 4The 1st Department of Internal Medicine, Yamaguchi University School of Medicine pp.97-102
Published Date 1979/1/25
DOI https://doi.org/10.11477/mf.1403107603
  • Abstract
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 The recognition of benign lesions which may mimic to gastric malignancy is of obvious importance to physicians.

 A 46 year old Taiwanese man, a primary school teacher, was transferred to Taipei Municipal Jen-Ai Hospital under diagnosis of inoperable cardia cancer, complaining of three years hunger pain and body weight loss of 5 kg in recent 3 months. Endoscopically, as well as radiologically, the case was interpreted as submucosal tumor simulating leiomyosarcoma, having multiple ulcers in the giant folds and bridging folds which occupied cardiac body. On operation, a palpable large thick indurated mass, fist-size, involving cardiac body except a small part of antrum, having adhesion with transverse colon, greater omentum and pancreas was revealed. Eventration of the left diaphragm was observed but without adhesion. Proximal gastrectomy, esophagogastrectomy, transverse colon segmental resection and primary anastomosis with pyloroplasty were performed. Post-operative subphrenic abscess and atelectasis of the bilateral lower lobes were noted .and needed fiberbronchoscopic aspiration and frequent suction.

 The complications were overcome finally and the patient was discharged after complete recovery.

 The resected specimen showed three giant ulcers (A) 5.5×2.5×0.5 cm, (B) 2.0×1.5×1.3 cm, (C) 3.5×2.5×0.5 cm, (and two ulcer scars) penetrating the subserosal layer with polypoid mass, and giant folds forming a large mass measuring 12×12 cm occupied body and fundus of the stomach. On cutting, the polypoid lesion showed whitish myxomatous in appearance, elastic in its consistency and mainly located in the submucosal layer. Microscopic examination showed peptic ulcer of Ul-IV with eosinophilic infiltration in the ulcer bases. Marked interstitial fibrosis involved the submucosal layer and infiltrated by inflammatory cells with perivascular whorling of loose fibrous tissue. Regional lymph nodes all 19 in its numbers showed hyperplasia with eosinophilic infiltration.


Copyright © 1979, 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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