A case of minute signet-ring cell carcinoma of the stomach which was difficult to diagnose and to decide the treatment procedure

Abstract

A 67-year old man underwent endoscopic examination because of abnormal findings in upper GI series at the other hospital. Multiple erosions were observed at the lower gastric body and the antrum. And histological findings of the biopsied specimen at the anterior wall of the lower gastric body showed signet-ring cell carcinoma. Although endoscopic findings at our hospital showed the same as ones there, however histological findings of the biopsied specimen could not reveal malignancy. After 1.5 and 3 months, the patient underwent endoscopic examination again, however malignancy was not detected. Nine months after primary examination, slightly depressed lesion with small redness (0'IIc type) was obseved at the greater curvature of the lower gastric body in the fourth endoscopy, and histological findings showed signet-ring cell carcinoma. The best treatment among gastrectomy, local resection of the stomach and endoscopic mucosal resection was discussed. As histological typing was signet-ring cell carcinoma, 9 months had been already passed from the first diagnosis, and it was difficult to detect the site of this lesion, distal gastrectomy was selected. Hisotological findings of resected specimen showed minute signet-ring cell carcinoma (0IIb type) 3 mm in diameter in the lamina propriae mucosae without vascular invasion and lymph node metastasis. Strict diagnosis and decision of the treatment were difficult in this case.