微小胃癌の2例―未分化型癌と分化型癌

Minute Gastric Cancers: Undifferentiated and Differentiated, Report of Two Cases

要旨　臨床的に発見された未分化型癌と分化型癌の2例を呈示し，所見の対比検討を行った．未分化型癌症例の患者は59歳，女性．10年前から十二指腸潰瘍の診断のもとに近医で毎年内視鏡検査を受けていたが，胃体部病変を指摘されて当院を紹介された．胃X線，内視鏡検査で胃体上部後壁に浅い不整形の陥凹を認め，生検組織検査で未分化癌と診断され胃亜全摘術を施行した．癌は，大きさ4mmのadenocarcinoma mucocellulare（sig）であった．分化型癌症例の患者は70歳，女性．胸部異和感を主訴に近医を受診し当院を紹介された．胃X線，内視鏡検査で前庭部後壁に小さい陥凹性病変を認め，生検組織検査で分化型癌と診断され胃亜全摘術を施行した．癌は，大きさ5mmのadenocarcinoma tubulare，well differentiatedであった．2例を対比すると，共に陥凹性病変であったが，内視鏡的に，未分化型癌は境界鮮明で褪色調を呈し，分化型癌は境界やや不鮮明で発赤調を呈した．

　〔Case 1〕A 59-year-old woman visited our hospital because of a gastric abnormality detected by panendoscopy performed for duodenal ulcer. The lesion was a tiny and whitish depression and diagnosed as adenocarcinoma mucocellulare (sig), 4 mm in size (Figs. 1-6).

　〔Case 2〕A 70-year-old woman visited our hospital because of epigastric discomfort. A lesion demonstrated by radiological and endoscopic examination was a tiny and reddish depression, subsequently diagnosed as adenocarcinoma tubulare, well differentiated, 5 mm in size (Figs. 7-12).

　These two cases were compared regarding endoscopical findings. Undifferentiated type gastric cancer had a clear margin and looked pale or whitish. Differentiated type gastric cancer, on the they hand, looked reddish with unclear margin.