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A CASE OF SUBMUCOSAL CYST DIRECTLY BENEATH AN EARLY CANCER Seiichiro Kishi 1 1Dept. of Internal Med. School of Medicine, Tokushima University. pp.1399-1403
Published Date 1969/11/25
DOI https://doi.org/10.11477/mf.1403110920
  • Abstract
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 In accordance with recent developement of examination methods in diseases of the stomach, there have been rapid progress in their diagnosis, as exemplified in the case here described which was that of an early gastric cancer of Ⅱc type with a cyst directly beneath it.

 The patient is a 62 year-old man. There is nothing noteworthy both in his familial and past histories. He came to the authors' hospital as he was advised to undergo a thorough check-up after he had been examined in a gastric mass survey in November 1968. Roentgenologically from the middle part of the corpus way to the incisura there was found a shallow depression stretching over the anterior and posterior walls with the lesser curvature as its center, together with abrupt cessation, thinning and worm-eaten state of the mucosal folds converging toward the lesion. It was diagnosed as Ⅱc type early gastric cancer. In the meantime, a smooth, broad-based protrusion was endoscopically observed within Ⅱc depression. This was diagnosed as a submucosal cyst directly beneath it. Biopsy under direct view disclosed carcinoma simplex mucocellulare. Operation was accordingly performed under the preoperative diagnosis of Ⅱc type early gastric cancer with a submucosal cyst directly beneath it.

 Gross finding of the resected stomach confirmed the preoperative diagnosis. Histologically the lesion was carcinoma simplex mucocellulare, extending widely within the mucosal layer with no vertical infiltration from the submucosal layer downward. In the submucosa there were cysts of various sizes, some solitary and some grouped together. This case was diagnosed simply as early gastric cancer, but on reflexion it seems that the existence of a depression too much absorbed the examiner's attention to fully notice a very low, broad-based tumor in a part of the depression, so that delineation and interpretation of the submucosal cyst was unsatisfactory. As it is apt to be overlooked also by endoscopy, scrupulous care must be paid in the observation of a gastric lesion. The cyst in this case, according to Palmer's classification, is akin to “endogenous cyst”, a rarely encountered tumor. There is no histological finding to corroborate any relation between the cyst and cancer.


Copyright © 1969, 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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