11年6か月間粘膜内にとどまったIIc型胃癌の1例

Early Gastric Cancer（Tubular Adenocarcinoma）Remaining in the Mucosal Layer for about 11 Years and 6 Months, Report of a Case

要旨　症例は64歳の男性．1991年11月に胃角部小彎からの内視鏡生検でGroup IVと診断された．1996年3月の再生検でGroup V，中分化型管状腺癌と診断され，当院に紹介された．当院で3回にわたる内視鏡生検を施行するも，癌組織の量が少なく，部位の確定には至らなかった．時間をおいての再検査を指示したが，その後11年6か月間受診することなく，放置されていた．2007年10月に胃集検で要精検を指示されて受診し，内視鏡検査で胃角部小彎のIIc型早期癌を診断された．低分化腺癌成分を含み，粘膜下層浸潤も疑ったため，外科的切除を施行した．病理組織学的深達度はpT1（M）であり，11年6か月間放置されたにもかかわらず粘膜内であり，緩除な発育を示した症例と考えられた．

　We reported a case of type 0 IIc early gastric cancer remaining in the mucosal layer for 11 years and 6 months. A 64-year-old man was suspected of having cancer cells that were classified as Group IV from a biopsy specimen of the lesser curvature of the angle in the upper gastrointestinal tract in November, 1991. He refused a more thorough examination. In March, 1996, he was found to have a gastric cancer（moderate differentiated tubular adenocarcinoma ; tub2）that was classified as Group V in Japan from a biopsy specimen of the lesser curvature of the angle which was at the same spot as that indicated in 1991, and he was referred to our hospital. These two upper gastrointestinal endscopies and biopsies showed no significant malignancy, but the third endoscopy and biopsy specimen showed Group IV, but we could not decide the focus. We advised him to take a more thorough examination, but he refused. In October, 2007, the appearance of the same lesion had changed and was diagnosed at biopsy as an early gastric cancer, type 0 IIc, poorly differentiated adenocarcinoma, and suspected of having invaded to the submucosal layer. Distal gastrectomy was performed. The resected specimen showed a poorly differentiated adenocarcinoma invading as far as the mucosal layer.