胃体部のⅡb＋Ⅱc型早期胃癌の1例

Type of Ⅱb+Ⅱc Early Gastric Cancer in the Gastric Corpus, Report of a Case

要旨　患者は62歳，女性．左季肋部痛を主訴に来院した．内視鏡検査で胃体部後壁に浅い線状潰瘍を発見，その周囲からの生検で癌と診断されたが，癌の範囲の診断は困難であった．X線検査で，線状陰影周囲に浅い不整形陰影斑が描写されⅡc病変と診断した．切除標本ではⅡc病変の小彎，幽門側に発赤した顆粒状粘膜のみから成る大きさ5.0×4.0cmのⅡb病変の拡がりを認めた．病理組織学的には癌は中分化型腺癌で，癌の腺管は粘膜中層に拡がり，その部にはびらんの形成が目立たず被覆上皮に覆われていた．この特徴的な組織像をとるとⅡb病変として存在する可能性がある．この症例では，Ⅱb部分は，X線的に粘膜ひだの不規則な消失，バリウムの付着異常として現れた．

　A 62 year-old woman was referred to our clinic with left epigastric pain. Endoscopic examination revealed a shallow, linear ulcer in the posterior wall of the gastric corpus. Adenocarcinoma was found in the biopsy specimen taken from around the linear ulcer. It was very difficult to detect the border of this lesion. Radiologically, this lesion was diagnosed as type Ⅱc early gastric cancer with shallow irregular-shaped barium fleck around the linear shadow. In the resected specimen, Ⅱb lesion was seen with reddish, granular mucosa, measuring 5.0×4.0cm, around the Ⅱc lesion in the lesser curvature and pyloric side.

　Histologically, the histological type of cancer was moderately differentiated adenocarcinoma and the cancer was spread in the middle layer of the mucosa covered with intact superficial epithelium, without superficial erosions. This characteristic histological finding is thought to be possible to form the Ⅱb lesion.

　In this case, Ⅱb mucosa was demonstrated radiologically as the area with the irregular disappearance of the mucosal folds and the unusual pattern of barium coating.