KODAMA Masanobu

Masanobu KODAMA

Department of Internal Medicine, Nishinokyo Hospital

Department of Internal medicine, Nishinokyo Hospital

キーワード :

【Introduction】
Advanced gastric cancer shows intragastric developmet in most cases and a case of gastric cancer with extragastric development is rare, accounting for less than 0.3％％of all resected gastric cancer. Although most of gastric cancer is diagnosed mainly by endoscopic examination, it is not possible to estimate extragastric development with endoscopy. On the other hand, ultrasonography can diagnose character of extramural growth. We present a case of advanced gastric cancer with extragastric development that was diagnosed with ultrasonography.
【Case report】
A 92-year-old man attended to our hospital because of poor appetite. Laboratory test revealed severe anemia（Hb 5.1g/dl）. We presumed that gastrointestinal bleeding caused anemia. Endoscopy showed a large elevated lesion with easily bleeding ulcer at lesser curvature of the body of the stomach. Although biopsy was performed, we cannot get the histological finding of cancer. We presumed the possibility of the disease except gastric cancer, such as GIST, and then performed ultrasonography. Ultrasonography demonstrated a hypoechoic oval mass between the stomach and the liver, which is consecutive with the wall of the stomach. Layer structure of the wall of the stomach was destroyed. In detail, the tumor is lobular to a slight degree and the margin of tumor is irregular slightly. Color flow imaging showed that the tumor is not abundant in vascularity. After ultrasonography, the endoscopy was performed again. The tumor was histologically diagnosed as poorly-differentiated adenocarcinoma with multiple biopsies.
【Discussion】
In general, advanced gastric carcinoma shows wall-thickening of the stomach in ultrasonographic image, while advanced gastric cancer with extragastric development forms mass in extragastric space. Ultrasonographic image of GIST is similar to that of advanced gastric cncer with extragastric development. Both diseases show low-echoic mass which is consecutive with the wall of the stomach. It is known that GIST is consecutive with the wall of the forth layer of the wall of the stomach in ultrasonographic image and that the layer structure of the stomach is not destroyed in GIST. Most of GIST is abundant in vascularity and is not accompanied with swelling of lymph node. On the other hand, ultrasonographic image of advanced gastric cancer with extragastric development is consecutive with the wall of the stomach and the wall structure of the stomach is destroyed. Advanced gastric cancer is sometimes accompanied with swelling of lymph node. Based on ultrasonographic fingings, we could diagnose advanced gastric cancer with extragastric development. In the present case, ultrasonography is useful to diagnose advanced gastric cancer with extragastric development.