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Japanese

Minute Gastric Cancer Detected by Serial X-ray and Endoscopic Examination, Report of a Case H. Yamaguchi 1 , S. Yoshida 1 , Y. Oguro 1 , K. Ushio 2 , M. Sasagawa 2 , T. Yamada 2 , T. Okada 3 , T. Hirota 3 1Department of Internal Medicine, National Cancer Center Hospital 2Department of Diagnostic Radiology, National Cancer Center Hospital 3Department of Pathology, National Cancer Center Hospital pp.269-274
Published Date 1982/3/25
DOI https://doi.org/10.11477/mf.1403108793
  • Abstract
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 We presented a case of a 61-year-old woman with minute gastric carcinoma which had been diagnosed after five times of x-ray and endoscopic examinations performed within three months. The lesion finally detected was on the anterior wall of incisura angularis and its size was less than 5 mm (4×3 mm).

 Roentgenographically and endoscopically, no ulcerative findings (e.g. converging folds) and no polypoid appearance were detected on this lesion and it was only seen as a simply shallow depression with vague discoloration. The above appearance was quite difficult to be diagnosed as malignant only from the conventional macroscopic criteria of early gastric cancer.

 In recent years, the macroscopic appearance of early gastric cancer detected has changed to be much flatter. Especially those which do not show any converging folds or polypoid appearance have been increasing rapidly. We call them “early cancer with gastritis-like appearance”. They are difficult not only to be diagnosed as malignant but to be detected as gastric abnormalities, whatever is their size. According to our prior reports, the macroscopic findings of early cancer with gastritis-like appearance were summarily expressed as “mucosal irregularities”, that was to say, the irregularities in erythematous change, granular lesion, discoloration and simply shallow depression of the surface mucosa. The minute cancerous lesion presented corresponds roentgenographically and endoscopically to the above category.

 On the posterior wall of the lower body, apart from the cancerous lesion, the patient had an ulcerative lesion which was macroscopically suspected of malignancy. In the previous examinations, most of our attention had been paid on this ulcerative lesion. But no malignant cell was detected histologically in the serial examinations with biopsy. After four negative examinations, cancerous lesion was finally detected on another site of the stomach.

 With retrospective and precise observation on the endoscopic films taken at the initial examination, however, faint abnormality such as a minute discoloration could be checked on the same site with the final cancerous lesion. At that time, the above finding was not recognized as abnormal and the cancerous lesion had been overlooked without taking close-up observation.

 The above may show that in the survey of the stomach both precise observation (visual diagnosis) and fair photograph (close-up view) are indispensable especially in case of the detection of early cancer with gastritis-like appearance. All through the examination we must pay attention on the localized mucosal irregularities. And if it be found, the malignancy should be checked by correct biopsy.


Copyright © 1982, 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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