Advanced gastric cancer simulating early gastric cancer is increasing tendcncy due to development of diagnostic technology. A 64-year-old woman was admitted for epigastric discomfort. Endoscopy showed a small white mucus coated erosion and peripheral mucosal nodurarity on greater curvature side of antrum. Biopsy was resulted in adenocarcinoma. An upper GI series and abdominal sonography were normal. At surgery, advanced gastric carcinoma, Borrmann localized type IV in background of early gastric carcinoma, prepyloric antrum along the greater curvature with infiltration to the muscle layer and multiple lymphatic tumor emboli in serosa and perigastric adipose tissue and neural invasion and metastasis to 12 out of 28 perigastric lymph nodes with extranodal extension. 3 months later, distant metastasis such as cervical lymph node, pleural effusion, pericardial effusion, peritoneal seeding and ascites were noticed.
Adenocarcinoma ; Adipose Tissue ; Ascites ; Biopsy ; Endoscopy ; Esophagus* ; Female ; Humans ; Intestines* ; Lymph Nodes ; Middle Aged ; Mucus ; Neoplasm Metastasis ; Pericardial Effusion ; Pleural Effusion ; Serous Membrane ; Stomach Neoplasms* ; Stomach*

BACKGROUND/AIMS: Helicobacter pylori is found in more than 90% of patients with gastric mucosa-associated lymphoid tissue (MALT) lymphoma. Regression of lymphoma after H. pylori eradication was reported. Therefore, early detection of gastric MALT lymphoma is important. On reported several endoscopic findings, nonspecific gastritis with erosion and ulceration were common and there is no typical endoscopic findings. METHODS: Therefore we analyzed the endoscopic findings of 16 low-grade B-cell gastric MALT lymphoma confirmed by biopsy, PCR and immunostain and compared histologic change after eradicating H. pylori infection in patients who refused operation retrospectively from March 1995 to October 1996. RESULTS: The male: female ratio was 7:9 and mean age was 43,7 years ald (23-71 yr), On endoscopic findings of gastric MALT lymphoma, irregular shaped geographic superficial ulcer was 7 cases (43.7%), diffuse mucosal nodularity was 4 cases (25.0%) and erosion was 3 cases (18.7%). The most common site of MALT lymphoma was antrum and angle. H. pylori was positive in 87.5% (14/16 cases) and eradication of H. pylori was done in patients who refused operation and histologic improvement after H. pylori eradication was found in 62.5% (5/8 cases). CONCLUSIONS: The most common endoscopic findings of gastric MALT lymphoma was irregular geographic superficial ulcer but diffuse mucosal nodularity and erosions were also common. Therefore, biopsy must be taken, especially on the antrum and angle although nonspecific lesion may be suspected.
B-Lymphocytes ; Biopsy ; Endoscopy ; Esophagus* ; Female ; Gastric Mucosa* ; Gastritis ; Helicobacter pylori ; Humans ; Intestines* ; Lymphoid Tissue* ; Lymphoma* ; Lymphoma, B-Cell, Marginal Zone ; Male ; Polymerase Chain Reaction ; Retrospective Studies ; Stomach* ; Ulcer