表層拡大型早期胃癌の1例

A Case of So-called Superficial Spreading Type Early Gastric Cancer (grouped Ⅱa and Ⅱb-like Ⅱc)

　広範な集簇したポリポイド病変（Ⅱa）と，それに接して，噴門側に極く浅い陥凹病変（Ⅱb様Ⅱc）を有した，いわゆる，表層拡大型早期胃癌を経験したので報告する．

症例

　患　者：43歳女子

　主　訴：心窩部痛

　家族歴：特記すべきことなし．

　既往歴：気管支喘息．

　現病歴：昭和40年頃から食事とは無関係の軽度の心窩部痛があり，某内科医を訪れ，胃X線検査の結果，慢性胃炎の診断を受けた．その後，内科的治療で症状の軽快を認めたが，昭和47年6月頃から同様の症状が現れ，X線検査の結果，胃潰瘍と診断された．治療の結果，症状は不変で，昭和48年6月に再度X線検査を受け，内視鏡検査をすすめられたため，同12日に高原中央病院を受診した．なお食欲は普通で，体重減少なども気付いていない．同20日に胃切除の目的で，日赤長崎原爆病院へ転医し，同年7月2日に幽門側胃亜全摘術を受けた．

　現症：体格中等度．栄養やや不良．理学的所見，一般血液ならびに血清学的検査に異常を認めず．胃液検査（ガストロテスト）は無酸．便潜血反応陰性．血清総蛋白 7.0g/dlであった．

　Case: 43-year-old female.

　She visited Takahara-tchûô Hospital with chief complaint of pain in the upper abdomen, and underwent an upper gastrointestinal tract series and endoscopic examination, which revealed many small protruded lesions on the mucosa of gastric angle and body.

　She underwent subtotal gastrectomy at Japanese Red Cross, Atomic Bomb Hospital.

　Pathological findings of the resected stomach: Grossly, it showed so-called superficial spreading type of carcinoma, extending from mid-body to angle of the stomach, with small irregular protruded lesions (grouped as Ⅱa), and shallow depression (Ⅱb-like Ⅱc) adjacent to the oral magin of the former.

　Histologically, there were intramucosal well differentiated tubular adenocarcinoma and poorly differentiated muco-cellular adenocarcinoma of the stomach, without metastases to lymphnodes.

　It was found by serial sections that many small cancerous glands were scattered superficially in the propria mucosa, adjacent to the carcinoma mass and fusing into one or several normal gastric glands. In this case, following points are interesting.

　1) Although this case is a middle-aged female, she has a well differentiated tubular adenocarcinoma of the stomach, which shows many small protruded lesion (grouped as Ⅱa).

　2) Gastric biopsy is useful for differential diagnosis, and for determining the extent of cancerous invasion.

　3) Dissemination of carcinoma cells in the superficial propria mucosae through interstitial space shows a possible mode of spreading of early gastric carcinoma.