A case of early gastric carcinoma with acute gastric mucosal lesions presenting difficulty in differentiating advanced gastric carcinoma.

An 87-year-old man diagnosed as having advanced gastric carcinoma was admitted to our hospital. In a barium X-ray examination of the stomach taken at another hospital, filling defects were obseved in the greater and lesser curvatures of the antrum, while the entire pyloric region was rigid and stenotic. The gastroscopic findings showed pronounced curvature and stenosis of the pylorus and the pyloric mucosa was edematous and sclerotic. Histopathological examination of a biopsy specimen from the pylorus indicated a group V. The gastroscopic findings subsequent to admission displayed pronounced improvement with only sporadic shallow ulceration and erosion. The histopathological findings of the excised specimen showed that several depressed lesions in the antrum were active ulcers or their scars and the depressed lesions extending from the antrum to the pyloric ring were early gastric carcinoma. The findings of filling defects of the antrum and stenosis with ridigity of the pyloric region in the radiographic examination, and pronounced curvature and stenosis of the pylorus and sclerosis with edema of the pyloric mucosa in the gastroscopic examination were very similar to typical findings of advanced gastric carcinoma with pyloric stenosis. In addition, histopathological examination of a biopsy specimen from the pylorus indicating a group V made differentiation from advanced gastric carcinoma extremely difficult.