範囲および深達度診断に苦慮したⅡc型早期胃癌の1例

Type Ⅱc Early Gastric Carcinoma: Difficult to Diagnose the Extent and Vertical Invasion of the Lesion, Report of a Case

要旨　患者は50歳，女性．1992年9月，心窩部不快感を主訴に来院．胃内視鏡検査で前庭部後壁のⅡc型早期胃癌と診断した．病理組織学的には最大径4.5cmの印環細胞癌で，深達度はsmであった．しかし，X線・内視鏡像ともにsmを示唆する所見に乏しく，また，病変の拡がりに関しても，mの部分で癌細胞が全層性の場所と，その周囲に既存の腺窩上皮と固有胃腺の間を疎に浸潤する場所がみられ，多彩な像を呈していた．本病変は印環細胞癌の浸潤様式を考えるうえで示唆に富む症例であり，画像診断と切除標本の対比の重要性が改めて認識された．

　A 50-year-old femele with epigasric discomfort visited our hospital in September, 1992. On endoscopic examination of the stomach, a depressed lesion (type Ⅱc signet-ring cell carcinoma, sm) was found in the posterior wall of the antrum. Dye-spraying method revealed further extension of the lesion from the clear depressed area. However, it was difficult to diagnose the clear margin of the lesion and the depth of submucosal invasion. Double contrast radiograms revealed almost the same findings as those of the endoscopy. By examination of the macroscopic and histopathologic findings of the surgical specimen, it was found that the lesion was composed of a central deep depression and a surrounding shallow depression. In the shallow depressed area, normal foveolar epithelium existed and tumor cell density was low. This made it difficult to point out the clear margin of the lesion. Considering this, it is very important to compare the image diagnosis and the clinicopathologic findings.