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Early gastric cancer composed of signet ring cell carcinoma is usually present as a depressed lesion and rarely manifests as a protruding lesion. To our knowledge, only eight cases have been reported in the literature. We herein report such a rare lesion which developed in an asymptomatic 55-year-old man.

We report a case of a 53-year-old male with Vibrio cholerae non-O1 (serotype O19) infection, resulting in perforative pan-peritonitis. The patient had a history of gastric cancer and a gastrectomy was performed one year prior. The patient had previously been admitted with nausea and vomiting and was diagnosed with a sub-ileus condition. He was provisionally discharged when his condition improved and during that period he ate raw fish caught locally in Nagasaki Prefecture, and several hours later he experienced a sudden onset of severe abdominal pain and nausea and on diagnosis of pan-peritonitis an emergency resection of the transverse colon was performed. We subsequently isolated Vibrio cholerae non-O1 from the patient's peritoneal fluid and stool. He died of multiple organ failure three weeks later despite intensive chemotherapeutic care and treatment for shock and disseminated intravascular coagulation. The strain of Vibrio cholerae non-O1 isolated was non-toxigenic but hemolytic with hyper-producing of metalloprotease.

Of 370 patients who underwent a resection for early gastric carcinoma, 317 (85.6%) were N(-), 28 n1(+), 20 n2(+) and five (1.4%) n3 respectively. In this study, n3(+) early gastric cancers were clinicopathologically evaluated and sites of the metastatic nodes were also defined. In addition, a comparative study in DNA ploidy patterns between primary and metastatic node cell was performed according to Hedley's method using a FACS-IV scan of paraffin-embedded tissues. All n3(+) early gastric cancers showed an aneuploidy pattern. R2 or R3 operations are recommended for early gastric carcinomas with aneuploidy pattern and most of the metastatic nodes arise from the identical stem cell line of cancer cells.

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