A CASE OF EARLY GASTRIC CANCER WITH LYMPHOID STROMA FOLLOWED-UP FOR THREE YEARS

Abstract

The patient was a 69-year-old woman with a complaint of epigastric discomfort, who had been previously pointed out to have a submucosal tumor of the stomach. Radiological and endoscopic examination revealed an elevated lesion with irregularshaped excavation on the anterior wall of the gastric corpus (Figure 1, 2). Possibility to be a submucosal tumor was considered, but diagnosis of this lesion by means of endoscopic biopsy was group V, unexpectedly. Subtotal gastrectomy was performed. The lesion, 2.5 cm in the largest diameter, looked like a submucosal tumor macroscopically (Figure 3). Pathological examination revealed undifferentiated adenocarcinoma, with an invasion to sm. Cancerous infiltration was limited within the excavated area in the mucosal layer, and limited within the sharply circumscribed mass, in which cancer cells were involved with a remarkable lymphoid hyperplasia, in the submucosal layer (Figure 4). These findings led to the diagnosis of a so-called gastric cancer with lymphoid stroma which was known to have a favorable prognosis. Change in its shape could not be recognized fundamentally, and an increase in its largest diameter was only 5mm during three years retrospectively (Figure 5, 6). Diagnosis by means of the 4 times of previous biopsy was Group I or II invariably. The patient is alive about 15 months after the operation. The present case is considered to be valuable to evaluate the growth rate and the prognosis of a gastric cancer with lymphoid stroma.