A Gastric Ulcer Looked Like Benign Lesion Developing into Typical Diffusely Infiltrating Gastric Cancer After Three Months, Report of a Case Taiji Akamatsu 1 , Kazuhisa Shimodaira 2 , Yuichi Nozawa 2 , Yasuhiro Kuraishi 2 , Hiroyuki Uehara 2 1Endoscopy Center, Nagano Prefectural Suzaka Hospital, Nagano Prefectural Hospital Organization, Suzaka, Japan 2Department of Internal Medicine, Gastroenterology, Nagano Prefectural Suzaka Hospital, Nagano Prefectural Hospital Organization, Suzaka, Japan Keyword: 潰瘍性病変 , 良悪性 , 鑑別診断 , びまん浸潤型胃癌 , 原発巣 pp.927-933
Published Date 2017/6/25
DOI https://doi.org/10.11477/mf.1403201108
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 A man in his seventies was referred to our department complaining of upper abdominal pain. He had undergone coronary artery stenting for the treatment of acute myocardial infarction 3 days previously. The patient's first EGD revealed gastric ulceration anterior to the middle portion of the lesser curvature. The endoscopic finding of the ulceration showed no remarkable malignant appearance. Biopsy specimens were not taken at this time because of concurrent anticoagulant therapy, and a proton pump inhibitor was administered to the patient. A subsequent EGD(6 weeks after the first EGD)revealed a reduction in the extent of the lesion, and regenerative gastric mucosa was observed around the ulceration. The patient's third EGD(12 weeks after the first)revealed a slightly protruded cicatrix that was surrounded by whitish mucosa and an irregular depressed lesion. Poor extension of the antrum, which had not been previously noted, was also observed. Histological biopsy specimens taken from the whitish mucosa and irregular depressed lesion were diagnostic for signet ring cell carcinoma. Radiographic examination revealed diffusely poor extension of the distal gastric wall. From these findings, we diagnosed a diffusely infiltrating gastric cancer. Total gastrectomy was performed; however, tumor cells were histopathologically observed at the resected anal margin, as well as on the cytological examination of ascitic fluid.

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