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A CASE OF Ⅱb+Ⅱc+Ⅲ TYPE EARLY GASTRIC CANCER ON THE GREATER CURVATURE AS OF AN EXTENSIVE SUPERFICIAL SPREADING TYPE Shoji Kawamura 1 , Takaya Uchida 2 1Kawamura Hospital, Maebashi City 2Dept. of Internal Med., Nippon Medical School pp.87-90
Published Date 1970/1/25
DOI https://doi.org/10.11477/mf.1403111165
  • Abstract
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 The case: a 68-year-old male. Chief complaint: feeling of dullness. Laboratory results: Occult bood in the feces was negative. Urine, blood and liver function tests were normal.

 X-ray examination: Slight rigidity was noticed in upright barium filled pictures on the greater curvaure of the gastric antrum, where mucosal convergence was visualized both in double contrast and compression studies. Continuous grade-formation such as swelling and narrowing of the central portion clearly indicated the presence of a small Ⅱc+Ⅲ. However, in pictures in which the pliability of the gastric wall was retained, there was noticed in an oral area away from the center a step-formation as of a distinct hyperbolic curve, and granular formation was recognized in the mucosa in this shallow and wide depression. Irregular, abnormal areas were also noticed in regions outside the grade-formation. It was considered then that cancer was not restricted within the central part of the mucosal convergence but was more extensive; its sphere remained uncertain, however. Endoscopically biopsy was positive for cancer in all specimens taken from areas of engorgement, swelling and white exudate in the center of mucosal convergence.

 Gross and histological findings: A depression with Ul-Ⅱ mucosal convergence was seen on the greater curvature of the antrum. Its niveau was clearly on a different level from the surrounding areas associated with granular formation. In an area near the lesser curvature was recognized partly a stair-like like formation as of Ⅱc. Histologically the central part was Ⅱc accompanied with ulcer scar, and the surrounding parts were mostly Ⅱb with cancer invasion in the upper half of the mucosal layer, with only a slight part of it being Ⅱc. As a whole it was adenocarcinoma tubulare, measuring 9 by 6cm.

 In x-ray and endoscopical examinations of early gastric cancer, especially in a case like this, extensive Ⅱb with Ⅱc+Ⅲ, it is not only necessary to notice the different levels of mucosal niveau and changes of mucosal hue but also it is essential, for confirmation of the extent of cancer, to discriminate the normal mucosa from the malignant one by means of biopsy.


Copyright © 1970, 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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