A Case of Elevated, Superficial Spreading Type of Early Gastric Cancer

Abstract

A 78-year-old man had been treated for bullous pemphigoid with nicotinamide and steroid ointment, and examined for internal malignancies. He was diagnosed as elevated type of early gastric cancer (I＋IIa) by endoscopy and gastric biopsy (group V) . His past history was cerebral infarction and hypertension. Hypothalamus/adrenal function and immune function were normal. Distal gastrectomy and D1 lymph node dissection were performed with Billroth I reconstruction. Macroscopic examination revealed that elevated lesion was apparent on the specimen without mucosal tension. Once the mucosa of the specimen was spread with tension, the edge of elevated lesion became unclear. Tumor was 7×5 cm in size and diagnosed as elevated, superficial spreading type of early gastric cancer. Pathological examination revealed as papillary adenocarcinoma, m, aw (－) , ow (－) , n0 and stage IA. He was recovered quickly and discharged on 14th post-operative day. It was difficult to diagnose the edge of tumor spreading with mucosal tension in case of superficial spreading type of gastric cancer. Most of superficial spreading tumor have IIb-like invasion at the oral side of the cancer, so it is important to observe whether there is superficial invasion on the oral side of the cancer or not in this case.