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A Case of Ⅱa+Ⅱc Type Early Gastric Cancer Modified in its Shape by Cicatricial Mucosal Convergence Koji Maeda 1 1Dept. of Gastroenterology, Shizuoka Center Hospital pp.1485-1491
Published Date 1970/11/25
DOI https://doi.org/10.11477/mf.1403111170
  • Abstract
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 A 53-year-old man having no symptom to complain of was found at a gastric mass survey done two and a half months before the operation to have an abnormal run of the mucosal folds on the posterior wall at the height of the angle, so that he was adrnitted to hospital for its exact evaluation. The patient was 166cm tall, weighing 68.5kg. Occult blood in the feces was negative. Gastric juice showed anacidity. After repeated x-ray examinations, a shallow depression of irregular shape was visualized on the posterior wall at the gastric angle by the double contrast method with medium amount of air. The depression was surrounded with mucosal convergence looking like petals of chrysanthemum. By the same method with smaller amount of air, the outer margins of chrysanthemum-flower-like protrusions were delineated as a shallow radiolucent area. The same finding was obtained by proportioned compression as well. In the study of endoscopic examinations done three times, surrounding areas of swollen mucosal convergence could be retrospectively inter preted as Ⅱa, but the overall findings were such that they were regarded as caused by sm type Ⅱc As biopsy under direct vision disclosed tubular adenocarcinoma as seen in Ⅱa, operation was done under a provisional diagnosis of Ⅱa+ⅡQ. Subsequently the lesion proved to be Ⅱa+Ⅱc (CAT Ⅰ, SAT 2). The area outside the Ⅱa was elevated because of the remaining fundic glands, while the central area was depressed owing to their disappearance. In the midst of this area was a linear erosion having a scar in its center slightly reaching underneath the lamina muscularis mucosae. Such a striking mucosal convergence caused by so slight a scar was regarded as the result of fibrinous hyperplasia in the submucosal layer.

 Belonging to those who consider that developmental pattern of cancer is different between Ⅱa and Ⅱc, the authors wish to lay stress on the necessity of minute examination of any elevated area around a depression even in such a case as this which looked at a first glance like a Ⅱc lesion.


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

基本情報

電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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