Japanese

A Protruding Type of Advanced Carcinoma of the Stomach Followed up as a Polyp for Four Years, Report of a Case M. Furusawa 1 , M. Koga 1 , K. Soejima 2 , T. Okamoto 2 , N. Watanabe 3 1National Kyushu Cancer Center Hospital 2The Second Department of Surgery, Faculty of Medicime, Kyushu Uiversity 3Department of Radiology. Faculty of Medicine, Kyushu Uiversity pp.597-603
Published Date 1973/5/25
DOI https://doi.org/10.11477/mf.1403108474
  • Abstract
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 A case is reported of a small protruding lesion of the stomach, followed up by x-ray for four years up to the time of surgical intervention, when the tumor was confirmed as an advanced cancer. Changes observed by x-ray all through the time of follow-up have also been compared with histological changes of the resected specimen.

 The patient, a 36-years-old woman, had been followed up by x-ray since October 1964 for a pedunculated polyp, then considered benign, located on the lesser curvature of the body. In March 1967 (one year and a half before the operation), the tip of the polyp was noticed to have shrunk with pedicle hypertrophied and stiffened. An area suggesting a low elevation was also seen on the mucosa around the stalk. Retrospectively studied, it might have been cancer already then, but at that time we considered it benign. In August 1968 (four years after the time of initial x-ray) we noticed a well-circumscribed, broad-based protrusion at the site of the pedunculated polyp. Type Ⅰ early cancer was suspected then, and in the following month gastrectomy (R2) was performed. The resected specimen revealed on the lesser curvature of the corpus a broad-based protrusion, 3.0 by 2.5 by 1.5 cm, which was histologically papillary adenocarcinoma, its vertical growth reaching the subserosal layer.

 Cancer nests did not show any finding to warrant a diagnosis of adenomatous polyp, nor was there any around them even to entertain such a suspicion.

 One month after the surgical operation she again underwent laparotomy because of ileus developed in the interim. Metastases were found in both lobes of the liver and the patient died six months later.

 Study of the preoperative x-ray films along with the histological findings of the excised specimen seems to show that it could have been at first a benign polyp, cancer originating later either at the base of or around the stalk. Cancer infiltration could have destroyed the stalk, causing the tip of the stalk to fall off. The normal architecture of the stalk must also have been destroyed by malignant invasion.


Copyright © 1973, 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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