内視鏡的切除術を行った前庭部早期胃癌（印環細胞癌）の1例

Endoscopic Resection of Early Gastric Cancer (Signet-ring Cell Carcinoma) in the Antrum, Report of a Case

要旨　患者は65歳，男性．心窩部不快感を主訴に近医を受診し，胃内視鏡検査によって前庭部後壁にⅡc型早期胃癌が発見された．当科における胃X線検査，内視鏡検査では，深達度m．Ul（－）のⅡc型早期胃癌と診断した．病巣の最大径は，X線上15mmであり，組織型は印環細胞癌であったが，患者の同意を得て内視鏡的切除術（endoscopic resection，以下ER）を行った．しかし，ER標本で断端陽性と判定し，またER後の内視鏡検査で人工潰瘍の後壁側にわずかな癌遺残が確認されたため胃亜全摘が行われた．ER標本ならびに術後の組織学的検索でも癌は粘膜内にとどまっており，またリンパ節などへの転移はみられず，局所切除が完全であればERでも根治治療が可能であった症例と思われる．

　A 65-year-old male visited his home doctor because of epigastric discomfort and was diagnosed endoscopically as having early gastric cancer (type Ⅱc) in the posterior wall of the antrum. Cancer in situ without an ulcer or an ulcer scar was also detected by upper GI series and endoscopy at our hospital.

　The lesion, 15 mm in the longest diameter, proved pathologically to be signet-ring cell carcinoma. Endoscopic resection (ER) was performed with his informed consent.

　However, the wedge of ER specimen was judged to be positive for cancer cell. Cancer cells unresected were endoscopically recognized on the posterior side of the artificial ulcer. Subtotal gastrectomy was carried out. Histologically, cancer cells did not infiltrate to the submucosa without metastasis to the lymphnodes. Therefore, it seemed possible that ER brings about curative therapy only if the lesion is completely removed by ER.