sm浸潤部に著明なリンパ組織の増生をみたⅡc型早期胃癌の1例

Ⅱc Type Gastric Cancer Which Shows Marked Lymphoid Hyperplasia in Submucosa Corresponding with sm Invasion, a Case Report

症例

　患　者：K. H.　60歳　男

　主　訴：心窩部不快感

　家族歴・既往歴：特記することなし

　X線所見：深達度smのⅡc型早期胃癌

　肉眼所見：深達度mのⅡc型早期胃癌，粘膜凹部の大きさ14mm×13mm

　組織所見：深達度sm，組織型poorly differentiated adenocarcinoma，Ul-Ⅱの瘢痕と粘膜下層に限局したLymphoid hyperplasiaを伴う．

　切除胃肉眼所見（Fig. 1，2）切除胃は大彎やや後壁寄りで切り開いてある．病変は幽門より8cm噴門側の前壁にあり，粘膜陥凹の大きさは，14×13mmである．比較的境界明瞭な地図状の粘膜陥凹，集中する粘膜ひだ先端のヤセおよび中断などから，Ⅱcの診断は容易である．粘膜陥凹中心部のやや噴門側大彎寄りに粘膜ひだが集中し，そこに潰瘍瘢痕が存在することを示している．そして，粘膜ひだ集中中心部には小結節状の所見が認められる．

　A 60-year-old male patient visited our hospital with a complaint of gastric discomfort. The X-ray examination of his stomach revealed an early cancer of IIc type with invasion depth of submucesa (sm), which was surrounded by converging folds in the anterior wall of the lower body. In the resected stomach, the lesion was located in the anterior wall 8 cm oral from the pylorus ring and was 14×13 cm in size showing an irregular map-like excavation surrounded with converging folds.

　It was very difficult to tell macroscopically how deep the cancer had invaded the gastric wall. Histologically, the type of lesion was poorly differentiated adenocarcinoma with invasion degree of sm. The lesion was also involved with a remarkable lymphoid hyperplasia localized in sm.

　lnterestingly, X-ray examination done by double contrast study showed clearly a radiolucent lesion with submucosal invasion corresponding to the lymphoid hyperplasia, which was, however, not recognized macroscopically as a submucosal lesion. The compression X-ray study showed also a clear-cut margin of a radiolucent lesion suggesting the protruded lesion corresponding to submucosal lymphoid hyperplasia.

　The following conclusion was made : dynamic observation of double contrast study by changing the amount of air from small, moderate to large degree, could reveal the depth of cancer invasion in the gastric wall.