A case of early gastric carcinoma that showed a macroscopic morphological change in a short span of time

Abstract

A 62-year-old male patient complaining of epigastric pain was administered an antacid and his progress was watched. The symptom did not improve and upper gastrointestinal endoscopy showed early gastric carcinoma of Type 0-IIa＋IIc. In preoperative examinations, metastasis to lymph nodes was suspected from abdominal CT but there was no evidence of metastasis to other organs. About a month later, Barium meal examination showed a protuberant lesion with marginal fold convergence on the posterior middle body of the stomach, but there was no excavation and a diagnosis of Type I was given. Then gastrointestinal endoscopy was again performed. A protuberant lesion with fold convergence was observed and a diagnosis of Type 0-I was given. Next gastropylorectomy was performed and the endoscopic diagnosis of early gastric carcinoma of Type 0-I was confirmed. This was a case of carcinoma developing a remarkable morphological change from excavation to protuberance, which was considered as a deviation of morphological change from the malignant cycle. The antacid might have been responsible for this change and its potent anti-ulcer effect was suspected to have caused a rapid hyperplasia of the tissue. However, early gastric carcinoma developing a macroscopic change in a period of just about a month is an extremely rare case and the type of factors that accelerated such a protuberant proliferation is yet to be known. It is hoped to elucidate the mechanism in the future.