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Stomach and Intestine(Tokyo) Volume 26, Issue 7 （July 1991）

胃と腸 26巻7号（1991年7月発行）

Japanese English

症例

興味ある拡がりを呈した隆起性表層拡大型早期胃癌の1例 Superficially Spreading Elevated Type Early Gastric Cancer Showing Interesting Pattern of Spread, Report of a Case 光永篤 ¹ , 中尾京子 ¹ , 千葉素子 ¹ , 春木宏介 ¹ , 加藤明 ¹ , 横山聡 ¹ , 橋本洋 ¹ , 黒川きみえ ¹ , 小幡裕 ¹ , 村田洋子 ² , 長廻紘 ² , 鈴木茂 ² Atsushi Mitsunaga ¹ , kimie Kurokawa ¹ , Hiroshi Obata ¹ , Koh Nagasako ² , Shigeru Suzuki ² ¹東京女子医科大学消化器病センター消化器内科 ²東京女子医科大学消化器病センター消化器内視鏡科 ¹Department of Gastroenterology, Tokyo Woman's Medical College ²Department of Endoscopy, Tokyo Woman's Medical College キーワード：隆起性表層拡大型早期胃癌 Keyword: 隆起性表層拡大型早期胃癌 pp.808-813

発行日 1991年7月25日 Published Date 1991/7/25

DOI https://doi.org/10.11477/mf.1403102589

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要旨　66歳，女性．胃底腺および噴門腺領域全域を占める広範な早期胃高分化腺癌の1例を経験したので報告する．本症例は口側は食道・胃吻合線より肛側は胃角部まで萎縮した噴門および胃底腺粘膜全域にわたり，内視鏡的に表面に粗大顆粒状の凹凸と，所々にカリフラワー様の小隆起を伴う白色調を呈した厚みのある粘膜で覆われており，萎縮のない胃体部大彎粘膜領域および偽幽門腺領域とは明瞭に境界を成しているのが特徴である．また，病変部は15×11cmと非常に広範囲であるにもかかわらず，全割標本による検索ではsm層への浸潤を認めず，全体が広範なm癌であった．

　We report a case of superficially spreading elevated type early gastric cancer which spread in the entire gastric body and fornix with atrophy.

　The patient was a 66-year-old woman who presented with abdominal pain and general fatigue. X-ray and endoscopic examinations revealed a wide flat elevation with some cauliflower-like gross tuberous growth involving the entire gastric body and fornix with atrophy (Figs. 1-5). The boundary of the lesion precisely consisted with the f-line at anal side and the F-line at oral side (Figs. 3-5). Histological examination of the polypectomized specimen obtained from the largest polypoid lesion showed well differentiated papillo-tubular adenocarcinoma (Figs. 6-7).

　Total gastrectomy with extended lymph node dissection (R₂) was performed. With Alcian blue staining the lesion was stained darkly, which made the lesion more clearly demarcated (Fig. 9).

　Histological study of the resected specimen revealed well differentiated papillo-tubular adenocarcinoma at the polypoid lesion (Figs. 12-13) and very well differentiated tubular adenocarcinoma at the flat elevated lesion (Fig. 11). The lesions were measured 15.O×11.Ocm in size, with a depth of invasion of m (ly(－), v(－), INF_α) and no metastasis was found in the dissected lymph nodes.

　There have been some reports that early gastric cancer of superficially spreading elevated type expands monofocally with the center of the lesion usualy involved as deep as sm layer. However, we did not find sm invasion in all the lesions, suggesting multifocal growth in this case.

　It is known that superficially spreading elevated type gastric carcinoma occurs rarely in comparison with depressed type. Furthermore, our case is distinguished by huge size, 15×11cm in diameter, the largest ever reported so far.