Ⅱc型からⅢ型形成への経過が観察された早期胃癌の1例

Type Ⅲ Early Gastric Cancer in which a Morphological Change Was Observed Prospectively, Report of a Case

要旨　患者は67歳，女性．胃体部の潰瘍で経過観察中，X線検査で前庭部後壁に異常を指摘され，内視鏡で同部位にⅡc型病変を認め，生検で印環細胞癌が証明された．術前7日前の検査ではⅡc型の形態を確認したが，切除標本で，Ⅱc型の部位に一致して術前の形態と明らかに異なる巨大な急性潰瘍様の病変を認めた．病理学的検索では，前庭部の小彎から後壁にわたる45×25mm大のUl-Ⅲの巨大な潰瘍病変で，その辺縁全周に粘膜内に限局してわずかに印環細胞癌を認めるⅢ型早期癌であった．本例はⅡc型の癌の拡がりにほぼ一致して潰瘍化しⅢ型に変化した直後の状態を手術標本でとらえた，まれな症例と考えられた．

　A 67-year-old female was found to have an irregular mucosa at the gastric antrum during a radiological examination and visited our hospital for further examination. Endoscopically, Ⅱc type early cancer was detected, and biopsy specimens revealed signet-ring cell carcinomas. No remarkable change was observed at the endoscopy performed 7 days before operation.

　The resected specimen showed a giant ulcerative lesion at the site of Ⅱc area, which was proved to be an Ul-Ⅲ acute ulcer, 45×25 mm in size, pathologically. Cancer cells remained only at the margin of the ulceration.

　Prospectively, Ⅱc type was observed presenting the morphological change to Ⅲ type within a short period, and it was considered that the ulceration was occurred at almost the whole area of cancerous invasion.