A CASE OF SCIRRHOUS CARCINOMA OF THE STOMACH PROBABLY DEVELOPED FROM A MINUTE LESION IN THE BODY ON THE GREATER CURVATURE

A 52-year-old man was seen at the hospital because of nausea after meals lasting for about 19 days. Fluoroscopic examination of the stomach showed abnormal folds in the body on the greater curvature. The definite diagnosis could not be achieved even by biopsies performed two times. With both fluoroscopic and endoscopic findings strongly suggesting scirrhous carcinoma of the stomach, an operation was carried out, shich disclosed that marked infiltration into the serosa had already occurred. The patient died of carcinomatous peritonitis after 13 months. Excised specimens revealed minute ulcer lesions 2mm in diameter between the gastric folds in the upper body on the greater curvature. A histopathological examination showed that a poorly differentiated adenocarcinoma exposed on the mucosal surface involved only the bottom of the minute ulcer, with extensive invasion into sm to ss, and partly into se, covering almost whole-circumferentially from the upper body to angular notch of the stomach. The site was diagnosed as the primary focus. Early diagnosis of scirrhous gastric carcinoma is considered difficult because of the common site and characteristics of growth and infiltration patterns. It is thought that careful endoscopic search for minute ulcer lesions between the gastric folds is important to make an early definitive diagnosis, particularly in cases involving the gastric body on the greater curvature.