A CASE REPORT OF EARLY GASTRIC CANCER: Ⅱc+Ⅲ TYPE WITH HYPERACIDITY Tomoyoshi Shirane 1 1Yawata-seitetsu Hospital pp.1399-1404
Published Date 1968/10/25
DOI https://doi.org/10.11477/mf.1403110704
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Case: T. M. 38-years-old male

 The patient had been under treatment for moderate hypertension these four years. He began to complain of steady hunger pain and epigastric tenderness since one month ago. Present status: pain at the epigastrium by compression, but no resistance nor tumor palpable at the area. Clinical examinations: negative occult blood of fezes. Remarkably excessive gastric acid output after histamine stimulation. Radiographic finding of the stomach: in the film of double contrast technique, a shallow lesion of irregular shape was found on the posterior wall of the lower corpus.

 In the center of the lesion there was a small islet-like protrusion. The lesion was accompanied with relief convergency which disappeared at a distance from the lesion, Endoscopic finding of the stomach: a shallow ulcerous lesion was found on the posterior wall of the corpus. The lesion was irregular in shape and covered with thin whitish coat. A small reddish protrusion was found in the center of the lesion. Several small erosions were scattered around the lesion. Clinical (diagnosis: Ⅱc+Ⅲ type early gastric cancer (Ⅱc was suspected to be widely spread).

 Macroscopic finding of the resected stomach: on the posterior side of the lesser curvature of the corpus there was a shallow and irregular-sized ulcerous lesion (2.1 cm×1.2 cm in its spread). The lesion contained a pin-head sized protrusion colored in red in its center. Histological finding: intramucosal signet ring cell cancer with tubular formation. The small protrusion in the center of the lesion was occupied with regenerated non-cancerous epithelium (so-called “holy-place type”). The floor of the ulcer was lined with cancerous or non-cancerous regenerated epithelium. Several shallow non-cancerous erosions were found around the lesion.

 On account of these non-cancerous erosions, it was hard for us to get the correct evaluation the extent of cancer both by radiography and endoscopy of the stomach. In general the extent of a cancer lesion is apt to be overestimated when it is accompanied by benign erosionsaround it, which are presumably provoked by excessive acid secretion. In such a case, strict attention should be paid in deciding precisely what part of the focus is to be biopsied.

Copyright © 1968, Igaku-Shoin Ltd. All rights reserved.


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