A Case of Gastric Scirrhus Showing Disappearance of Ulcer in the Course of Follow-up K. Sasaki 1 , Y. Takasato 1 , M. Hisamatu 1 , T. Saito 1 , A. Saito 2 14th Dept. of Internal Medicine, Tokyo Medical College 2Saito Clinic, Utsunomiya pp.479-482
Published Date 1974/4/25
DOI https://doi.org/10.11477/mf.1403111796
  • Abstract
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 The patient, a housewife 58 years of age, complaining of pain in the epigastrium, was found at the initial examination by roentgenography and endoscopy to harbor an ulcer in the greater curvature side of the mid-body. Biopsy specimens taken from the ulcer margins were positive for cancer (adenocarcinoma mucocellulare). However, roentogenography and endoscopy done about one month later showed that the ulcer was gone and no erosion was in sight. One noticed only hypertrophy of the mucosal folds and rigidity of the mucosa in the greater curvature side of the middle corpus. Subsequent twice-conducted endoscopy examinations failed to exactly locate the ulcer scar. Biopsy specimens, totalling to 15 pieces, taken from in and around the greater curvature of the mid-dody where the ulcer had been noticed, were all negative for malignancy. Since the first biopsy was positive and overall pictures of roentgenography and endoscopy were highly suggestive of scirrhus, we performed total gastrectomy. Macroscopically the resected stomach was thickened in general and was of elastic hard consistency. The mucosal folds over the greater curvature of the body were hypertrophic. A scar-like finding was also noticed on the greater curvature of the mid-body with a hint of convergency of the thickened rugae there, but grossly it was hard to discern any Ⅱc finding. Histologic reconstruction of the resected stomach finally made it clear that an Ul-Ⅱ ulcer in the greater curvature of the mid-body was associated with a small area of cancer in the surrounding mucosa. On the other hand, in or beneath the submucosa was found extensive scirrhus (adenocarcinoma mucocellular) with only a small part of the pyloric antrum remaining free from malignancy.

 In retrospect, the present case was an extraordinary one, posing difficulty in clinical diagnosis (biopsy dia-gnosis) because we had to take into account of the so-called malignant cycle of ulcer as it had disappeared in its course and we had difficulty in locating it.

Copyright © 1974, Igaku-Shoin Ltd. All rights reserved.


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