Abstract
This paper deals with a case of large protruded early gastric cancer (Type I) adjoining depressed and excavated early gastric cancer (Type IIc+III).
In October 1969, 70 years old man who complained of epigastric pain and full sensation of the stomach visited our clinic.
X-ray and gastrofiberscopic examinations of the stomach revealed a large reddened tumor with polypoid surface at the gastric angle, and the tumor inconspicuously shifted to depressed area with some coated lesions at the lower gastric body and his illness was diagnosed as Borrmann I type gastric cancer next to IIc type early gastric cancer.
Gastrectomy was made on December 9, 1969 by Billroth I method. Resected specimen showed 5×5cm area of tumor at the angle adjoined to 3×6.5cm area of depressed lesion at the lower gastric body including single small ulcer formation near to the posterior border of the depressed lesion.
The histological examination revealed that tubular adenocarcinoma existed in both the tumor and the depressed lesion and the cancer invaded to the submucosa of the stomach at several sites, but no metastasis to the adjacent lymphnodes was found. And it was diagnosed as an early gastric cancer of Type I+IIc+III.
An interesting finding was the almost perfect similarity of histological types between protruded lesion (Type I) and depressed and excavated lesion (IIc+III), so the depressed and excavated lesion might be formed by superficial spread of the cancer cells in the tumor, on the other hand there was a possibility of bi-centric cancer formation.
