Abstract
A 75-year-old woman complaining of epigastric discomfort was performed upper gastrointestinal endoscopic examination and was found having stenosis at the pyloric part of stomach. No abnormalities were seen on the mucosal surface, but edematous stenosis was present at the pylorus. A biopsy revealed no malignant findings. An abdominal CT scan showed diffuse thickening of the gastric wall. The level of a tumor marker CA19-9 was as high as 735 U/ml. Although no definite diagnosis was gained, the patient was operated on for suspected malignancy, because no symptomatic remission was attained, the CA19-9 level was high and thickening of the gastric wall was demonstrated. The resected specimen included not thickening of the gastric wall but only hardening of the stenotic portion. Histopathologically no cancer was proved on the mucosal epithelia, and the diagnosis was made as submucosally invasive, well differentiated adenocarcinoma. Immunohistochemistry showed positive staining for CA19-9 and the elevated serum CA19-9 level was normalized after the operation. CA19-9-producing gastric cancer was thus diagnosed.
In the case of pyloric stenosis in which no abnormalities are seen on the mucosal surface and a biopsy provides no malignant findings, a possibility of cancer should be considered.
