比較的限局した胃スキルスの1例

A Case Report : Scirrhous Cancer of the Stomach at Relatively Localized Stage

症例

　患　者：42歳　男性

　主　訴：心窩部不快感

　術前診断：胃角部スキルス

　手術所見：腹水，腹膜播種，シュニッツララー転移，肝転移はなかった．リンパ節転移はなかった．

　術後診断：スキルス（粘膜面陥凹部の大きさは10×8mm，粘膜下腫瘍様隆起部の大きさは約61×37mm，浸潤範囲の広さは94×46mmである）．深達度s．組織型 Poorly diff. adenocarc., scirrhous．

　Case : a 42-year-old man

　Chief complaint : discomfort in the epigastrium

　Preoperative diagnosis : scirrhous cancer at the angle of the stomach

　Postoperative diagnosis : scirrhous cancer (the size of the cancer was 94×46 mm with an invasion depth of s degree. The histology of this cancer was poorly differentiated adenocarcinoma, scirrhous).

　Macroscopic and histological findings are summarized as follows:

　Ⅰ) The size of the depressed area was as small as 10×8 mm with a surrounding elevated area 61×37 mm in size.

　Ⅱ) The invasion of the cancer cells was limited to the depressed area in the mucosal layer and spread in the region over the elevated area as wide as 94×46 mm.

　This case was radiographically diagnosed as a scirrhous cancer at the angle of the stomach. The findings were composed of a IIc-like erosion, advanced and wide rigidity in the lesser curvature at the angle and limited extension of the greater curvature at the angle.

　The erosion was located on the submucosal tumor-like elevation with many mucosal folds. This elevation was induced mainly by thickening of the muscle layer.

　Histological infiltration of the cancer cells was mild in the submucosal layer and severe in the muscle layer. A fusion of mucosal and submucosal layer was observed only around the IIc-like erosion but no fusion of two layers was observed in other areas. This finding caused no visual change of mucosal folds and provided us with a difficulty to decide the limit of cancer infiltration.

　In summary, two points could be emphasized : One is a radiographic deformity of the mucosa looking as if a small electric bulb were put in underneath. This finding could be of interest for the diagnosis of scirrhous cancer. The other is a submucosal tumor-like elevation due to the thickening of the muscle layer, which would be of interest in considering a pattern of invasion of scirrhous cancer.