Superficial Spreading Ⅰ+Ⅱa Type Gastric Cancer with an Associated Ⅱb Lesion, Report of a Case Osamu Sato 1 , Mitsuru Kamata 2 , Syujo Goto 1 , Hiroko Ishikawa 1 , Fumishi Kooka 1 1Department of Gastroenterology, Iwate Prefectural Central Hospital 2Department of Pathology, Iwate Prefectural Cerrtral Hospital pp.63-70
Published Date 1985/1/25
DOI https://doi.org/10.11477/mf.1403109649
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 The patient was a 75 year-old woman whose hushand and son died of Borrmann Type 4 carcinoma of the stomach at the age of 65 and 46, respectively. In January 1983 she suffered from common cold and subsequently began to have epigastric pain, with which she consulted a certain doctor. At that time she was noticecd of her having an elevated lesion in the pylorus as revealed by stomach x-ray. She was referred to us on February 17 of the same year. Gastric x-ray and gastroscopy revealed a cauliflowerlike gross tuberous growth on the anterior wall of the pylorus and multiple elevated lesions with smooth surface of varying size over an area extending from the pylorus to the middle of the body. The borders of these lesions were indistinct on their superior side. On endoscopy the mucosa surrounding elevated lesions situated on the lesser curvature side of middle body appeared greyish white and there was noted a disorderly network of blood vessels, the presence of a Ⅱb lesion thus being suspected. Twelve biopsy specimens were taken mainly from elevated lesions. The cauliflower-like lesion of the pylorus was identified histopathologically as a Group Ⅳ carcinoma. Other elevated lesions were classified into Group Ⅳ or Ⅱ. Subtotal gastrectomy was performed. Macroscopic observation of the excised stomach disclosed numerous elevated lesions of varying size scattered over an area from the pylorus and the lower portion of the body and interjacent greyish white thickened mucosa. The upper boundary of the growth was ill-defined. Histologically, these lesions were demonstrated to represent a Ⅰ+Ⅱa+Ⅱb type tubular adenocarcinoma, 12.5×10 cm in size, with a depth of invasion of m and exhibiting extensive intestinal metaplasia.

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