Early gastric cancer, type IIc, difficult to confirm the site of the submucosal involvement, report of a case

The patient, a 44-yr-old woman, complained of epigastric discomfort since October, 1979. So, she visited Keio Univ. Hospital. The routine upper GI series on April 4, 1980, revealed an abnormality suggesting gastric cancer. The minute x-ray examination performed on May 1 revealed a wide depressed lesion in the anterior wall of the lower gastric body, which wasshallow but double-contoured and multiple granules were recognized within the inner deeper depression associated with a linear ulcer scar. Endoscopic examination on April 9 showed the same findings as those of the x-ray. By radiological and endoscopic examination, we diagnosed the lesion as IIc with submucosal involvement. Submucosal invasion of cancer cells was estimated to be accompanied with the linear ulcer scar. Surgical operation was carried out on May, 8, 1980. The pathological diagnosis of the resected specimen was undifferentiated adenocarcinoma. The size of cancerous lesion was 7.0 x 6.5 cm. Cancer cells were almost limited in the mucosal layer. Cancerous invasion 0.3 cm in the diameter was recognized in the submucosal layer apart from the linear ulcer scar. The area of submucosal involvement was too small to be recognized macroscopically, so it might be impossible to estimate it radiologically and endoscopically. Meanwhile, by retrospective evaluation of the preoperative findings, there were no definite signs for submucosal involvement.