COEXISTENCE OF Ⅱc WITH POLYPOID LESIONS (ATP) EXISTING INDEPENDENTLY OF EACH OTHER Tatsuhisa Nemoto 1 1The Seisho Research Society for Digestive Disease pp.81-86
Published Date 1970/1/25
DOI https://doi.org/10.11477/mf.1403111164
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 This is a case report of a 45-year-old man visiting the authors' hospital with hunger pain as his chief complaint. In his stomach was found a wide Ⅱc with the gastric angle as its center, coexistent with another polypoid lesion (Ⅱa-like aggregate of atypical epithelium) on the posterior wall of the antrum adjacent to the pyloric ring. They were located at some distance from, and independent of, each other

 At the initial examinations of x-ray and endoscopy, he was suspected as having Ⅱc or multiple ulcers coexistent with Ⅱa lesion. However, as his chief complaint disappeared by the administration of antiacid agents, further examination was neglected for 3 or 4 months. Surgical intervention was eventually performed 7 months later from the intial examination.

 It was early gastric cancer with the degree of depth invasion luckily localized mostly within the “pm”, with only a small part of it reaching the “sm”. No metastasis was found as far as the secondary lymph nodes (no, 0/33).

 This case is of interest from the following points: ――

 (1) Both roentgenologically and endoscopically, preoperative diagnosis was diflicult to make as to whether Ⅱc and polypoid lesion were independent of each other; conversely, it was hard to determine the extent of Ⅱc lesion, especially its pyloric border.  (2) In x-ray pictures, barium fleck over the area, where the gastric rugae were about to disappear, was of variegated shape so that multiple ulcers were suspected as well. Until the result of fibergastroscopic biopsy was made known, reactive lymporeticular hyperplasia had also been suspected as the extent of Ⅱc was impossible to determine.

 (3) The protrusion in the pyloric part was diagnosed as ATP by biopsy, but by both x-ray and endoscopy it was definitely and indubitably regarded as Ⅱa. Such a lesion as exists on the border area between benign and malignant lesions should be clinically dealt with at present as of malignant nature.

Copyright © 1970, Igaku-Shoin Ltd. All rights reserved.


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