粘膜病巣の大きさが2mmであった進行胃癌の1例

Advanced Gastric Cancer Whose Mucosal Lesion was 2 mm in Diameter, Report of a Case

要旨　患者は68歳，女性．胃集検後の精検により，胃体上部後壁の病巣を見いだした．X線検査では低い隆起の頂部に小陥凹を有する病巣が描出され，内視鏡検査では隆起は軽度発赤して，色素撒布により周囲粘膜と同様の小区像を有することが確認された．小陥凹からの生検で印環細胞癌が得られ，噴門側胃切除術を行った．切除標本で径1mmの小陥凹がわずかに発赤した低い隆起の上に存在した．組織学的には粘膜筋板は保たれているが，印環細胞癌が粘膜下層には線維化を伴って拡がり，一部は固有筋層の中に浸潤していた．癌浸潤範囲は粘膜層では2mm，粘膜下組織では10mmであった．prelinitis plastica型胃癌に相当する症例ではないかと推論された．

　A 68-year-old woman was diagnosed as having gastric cancer during a mass survey and was reffered to own clinic. X-ray examination showed a low protruding lesion with a minimal depression at a top on the posterior wall of the upper gastric body. Endoscopic examination showed that the protruding lesion was slightly reddish and had the same areae gastricae as the surrounding mucosa after dye spraying. Biopsy specimens from the depression histologically demonstrated signet ring cell carcinoma and proximal gastrectomy was performed. Macroscopically the depression on the top of the reddish protruding lesion measured 1 mm in diameter. Microscopically the muscularis mucosae was not destroyed but cancer cells had spread in the submucosal layer with massive fibrosis and had partly invaded in the muscularis propria. The size of the cancerous area was 2 mm in the mucosal layer and 10 mm in the submucosal tissue, respectively. It was thought that this case would belong to the category of “pre-linitis plastica” type gastric cancer.