CASE Report

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A 40-year old house wife was admitted to the hospital of Gunma University with a chief complaint of indigestion. Physical examination was normal. X-ray examination of stomach revealed two ulcer scar focuses with converging folds on the posterior wall just above the angulus. Endoscopical examination showed a slightly depres-sed area with a few folds converging to it. But the changes of the depressed floor was not remarkable and the so-called interruption of the folds were obscure. Two biopsy studies were negative for malignancy. The lesions were concluded to be cicatrices of ulcers. And the patient was discharged. After 3 months, the following endoscopecal examination revealed an early cancer of type II c with a reddish slightly depressed area on the angulus. Surprisingly, however, on the resected stomach a wide IIc area almost equivalent to a IIb lesion spreading on the anterior wall, and in other part, a true IIb lesion were found. Interestingly, the IIc lesion was consisted of two parts. The inner IIc area was more depressed comparing to the outer one, and it had been correctly diagnosed by the gastrocamera examinations but the outer part hadnot showed any endoscopical abnormalities the latter could be recognized only with a very careful inspection of the gross-specimen. On the other hand, the last true IIb lesion showed neither endoscopical nor macroscopic abnormalities ever after careful retrospective xaminations, and it was discovered only after a microscopic examination of the specimen. The cancerous invasion was restricted in the mucous membrane itself without a very limited area with submucosal invasion. A case of an early stomach cancer of type IIc+ IIb was reported. This case is very interesting because of suggesting the process of the cancer development.

CASE Report

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