噴門部前壁陥凹型早期癌（未分化型）の1例

Type Ⅱc Early Gastric Cancer at the Cardia, Report of a Case

要旨　患者は53歳，男性．12年前から毎年検診目的で上部消化管X線検査を受けていたが異常を指摘されていなかった．今回は胃内視鏡検査を行い，噴門部前壁にわずかに陥凹した褪色領域と点状出血を認め，生検で低分化腺癌の診断を得た．精密X線検査では，半立位腹臥位第1斜位二重造影像と半立位仰臥位第2斜位二重造影像とで，噴門部前壁に不整バリウム斑とその中の隆起，中断する皺襞と虫喰い像を描出でき，Ⅱc型早期癌と診断しえた．切除胃標本所見では，食道胃接合部から18mm離れて噴門部前壁に大きさ19×11mmのⅡcを認め，組織学的には低分化型腺癌，深達度mであった．

　A 53-year-old man underwent annual x-ray screening for gastric cancer in the past 12 years and the latest examination included endoscopy, although he was asymptomatic. Endoscopic examination with a forward viewing scope revealed a small rugged and discolored area in the anterior wall of the cardia. Biopsy of this portion was positive for cancer. Subsequent examination with a lateral viewing scope showed this discolored area as an irregular shaped, slightly depressed and somewhat granular lesion.

　Radiologically this lesion was shown as a faint irregular barium collection and irregularly arranged fine granules. Folds were interrupted at the edge of this lesion. The lesion was visualized only in half standing position, prone position, or first oblique position. Under the diagnosis of Ⅱc, total gastrectomy was performed on August 29, 1990. On the resected specimen, the lesion was irregular, slightly depressed and somewhat granular inside, rendering moth-eaten appearance of the adjacent fold. No ulceration was noted. The lesion, measuring 19×11mm in size, is located in the anterior wall of the cardia 18 mm from the EGJ. Histologically it was an intramucosal poorly differentiated adenocarcinoma.