Twenty cases of benign gastric ulcers preoperatively interpreted to be malignant were reviewed clinicopathologically to clarify why these ulcers grossly appeared malignant. Macroscopically, the lesions often had an irregular margin (75%) and elevated surrounding mucosa (45%), and were often located on the greater curvature (40%) and near the pylorus (40%). Microscopically, most ulcers were large (21 mm) and shallow, reaching the submucosa (70%), and many were characterized by marked fibrosis (35%) and inflammatory cell infiltration (25%), sometimes accompanied by lymphoid hyperplasia. For such ulcers, which look malignant, careful examination by radiography, endoscopy, and biopsy should diminish the indications for surgery.
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