A Case of Advanced Gastric Carcinoma in The Ⅱc+Ⅰ+(Ⅲ) Type Near the Cardia Tomiro Murakami 1 1The Seisho Society of Gastroenterologists pp.1137-1143
Published Date 1970/8/25
DOI https://doi.org/10.11477/mf.1403111344
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This is a case of advanced gastric carinoma near the cardia seen in 38-year-old female with a chief complaint of nausea. Previous x-ray examinations of the stomach done in March and July in 1967 were misinterpreted as showing nothing abnormal. At the end of May and in the first part of Jnne in 1969, a lesion in the shape of Ⅱc+(Ⅲ) was recognized by x-ray and endoscopic examinations just underneath the cardia extending to the lesser curvature of the upper body. Repeated examinations at the end of June prior to surgery revealed emergence of an additional polypoid lesion underneath the cardia and cancer was comfirmed by endoscopic biopsy. Preoperative diagnosis, there fore, was cancer in the type of Ⅱc+I+(Ⅲ), but the depth of infiltration was assumed to reach beyond the muscularis propria because of the extent of rigidity as seen in the x-ray films. On resection, the polypoid lesion below the cardia measured 2.2cm in diameter amd 1.0 cm in height.

Distal to it, extended the Ⅱc area along the lesser curvature, measuring 5×4.5cm in dimensions as a whole. In addition, puckering of the folds was noted, converging towards an area within the Ⅱc. Histologically, it was adenocarcinoma mainly confined to the mucosa and submucosa, with slight infiltration into the muscularis propria in areas and a nest of cells in a subserosal lymphatic channel. A special mention should be made that the polypoid lesion consisted of a mass of lymphoid tissue infiltrated by cancer. The rapid development of the mass, apparently within 25 days prior to surgery, may be explained by the additive growth of lymphoid and cancerous tissues. Previous failures in clearly demonstrating the lesion would indicate the difficulty in the diagnosis of lesions in the upper part of the stomach. The importance of combined use of x-ray and endoscopic examinations even at the screening step cannot be overemphasized.

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


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