Gurzu Simona, Copotoiu Constantin, Azamfirei Leonard, Jung Ioan
Department of Pathology, University of Medicine and Pharmacy of Tirgu-Mures , Romania .
J Clin Diagn Res. 2013 Aug;7(8):1717-9. doi: 10.7860/JCDR/2013/6385.3266. Epub 2013 Aug 1.
A 75-years old man was hospitalized with symptoms which suggested gastric cancer. Thirty-eight years ago, he had undergone a Billroth-II gastric reconstruction for a peptic ulcer. At the present admission, he had presented with an eight-month history of recurrent haematemesis, epigastric pain, vomiting, and fatigue. The emergent endoscopy showed a type 0-IIc (superficial depressed) early gastric stump cancer in the anastomotic area and total removal of the gastric remnant and the jejunal segment was performed. The histological examination of the surgical specimen showed a gastric adenocarcinoma that invaded the mucosa and the submucosa, without lymph node metastases (pT1bN0 stage). Besides the tumour, enlarged vessels were observed in the submucosa and the muscularis propria, some of which were thrombotic. The surrounding normal gastric wall also presented submucosal oversized vascular spaces, some of which were protruding through the muscularis mucosae in the mucosal layer. Based on these characteristics and the recurrent haematemesis, a final diagnosis of early gastric stump carcinoma which was associated with Dieulafoy's lesion was made. This association has not yet been reported in the literature and it allowed us to diagnose the gastric stump cancer in a very early stage.
一名75岁男性因疑似胃癌症状入院。38年前，他因消化性溃疡接受了毕罗Ⅱ式胃重建术。此次入院时，他有8个月反复呕血、上腹痛、呕吐和疲劳的病史。急诊内镜检查显示吻合口区有0-IIc型（浅表凹陷型）早期残胃癌，遂行胃残余和空肠段全切除。手术标本的组织学检查显示为胃腺癌，侵犯黏膜和黏膜下层，无淋巴结转移（pT1bN0期）。除肿瘤外，黏膜下层和固有肌层可见血管扩张，部分有血栓形成。周围正常胃壁也有黏膜下超大血管间隙，部分通过黏膜肌层突入黏膜层。基于这些特征和反复呕血情况，最终诊断为与Dieulafoy病变相关的早期残胃癌。这种关联尚未见文献报道，这使我们能够在极早期诊断出残胃癌。
