早期胃癌の内視鏡的切除後の経過観察中に発見された胃体部の微小印環細胞癌（Ⅱb）の1例

Minute Signet-ring Cell Carcinoma (Ⅱb) of the Gastric Body Discovered by Follow-up after Endoscopic Resection of Early Gastric Cancer

要旨　患者は54歳，女性．幽門前庭部のⅡcの内視鏡的切除後の経過観察中1年1か月して，内視鏡検査で胃体部後壁に微小な白斑を認め，1個の生検で印環細胞癌を証明．生検後14日の内視鏡検査で，生検前の小顆粒状白斑の中心に陥凹と周囲粘膜の軽度の隆起を認め，生検前後の変化を確認しえた．病巣は5mm以内で，粘膜層にとどまり，瘢痕もなく，内視鏡的切除を施行したが，穿孔を起こし胃切除を行った．内視鏡的切除標本では，印環細胞癌が粘膜層にとどまり，びらんもなく，径4mmで，Ⅱbであった．粘膜下層に比較的広範囲の線維症を認めた．微小印環細胞癌の生検前後の内視鏡所見と瘢痕像の関連を検討した．

　A 54-year-old female who had a Ⅱc cancer of the antrum endoscopically resected one year and a month previously developed another lesion, a minute white spot, in the posterior wall of the gastric body. Endoscopic biopsy was performed showing signet-ring cell carcinoma. Next endoscopic examination performed 14 days later showed an interval change in the mucosa, i.e., mildly elevated mucosa surrounding a minute granular white spot with central depression. The lesion, measuring 5 mm or less, was limited to the mucosal layer without scarring. Endoscopic resection was done but resulted in perforation of the wall. Gastrectomy was thus carried out. The specimen of endoscopic resection was positive for signet-ring cell carcinoma, 4 mm in diameter, limited to the mucosal layer. This lesion lacked erosion and was classified as Ⅱb early gastric carcinoma. Diffuse fibrotic change was found in the submucosal layer.

　Discussion was made on the endoscopic findings before and after biopsy procedure for minute signet-ring cell carcinoma.