Ⅱc＋Ⅱa型早期胃癌の1例

A Case of Widespread Ⅱc＋Ⅱa Type Early Gastric Cancer

　最近の胃癌診断学の進歩は著しいものがあるが，比較的平坦で広範な早期胃癌の診断は微小癌の見つけ出し診断とともに，いまだなかなか難しいものである．広い胃癌の正確な診断は手術に際しても重要な問題であるが，今回われわれは術前にほぼ満足のゆく診断の得られた広範Ⅱc＋Ⅱa型早期胃癌の1例を経験したので報告する．

症例

　患　者：吉○　資　76歳　男性

　主　訴：なし

　既往歴・家族歴：特記事項なし

　現病歴：約15年来ほぼ毎年自宅近くの病院で胃X線検査を自発的にうけていたが，昨年までは異常を指摘されたことはなかった．1977年5月同様に胃X線検査をうけたところ異常を指摘され，自分から精査を希望してわれわれのところに来院した．

　理学的検査，血液生化学検査等に異常所見なし．

　X-ray examination of a 76-year-old man, who had no past history or subjective symptoms that are applicable to the present disease, showed an elevated petal-like appearance of an edge-shaped curving series of wave crests which were found on the anterior wall of the antrum. In the double contrast study, polypoid lesions of various sizes and shapes were crowded together on the posterior wall from the lesser curvature of the upper corpus to the antrum. The presence of a IIc lesion which was adjacent to the polypoid lesion on the posterior wall of the corpus was faintly seen. The gastric wall of the lesion spread well.

　Endoseopy showed a discolored petal-like appearance of an edge-shaped curving series of wave crests on both the anterior and posterior wall of the antrum, and this appearance spread continuously to the anterior wall of the upper corpus. The IIc lesion was recognized as a red, shallow, depressed lesion in the posterior wall of the corpus, followed by the Ⅱa lesion described above. These X-ray and endoscopic findings led us to a diagnosis of widespread Ⅱc＋Ⅱa type early gastric cancer.

　Microscopically the lesion was of rounded shape, measuring 8.0×8.0 cm, with a central erosion. The petal-like Ⅱa lesion occupied the entire anterior half and the posteroanal quarter of the lesion, and the adjacent Ⅱc lesion occupied the posteroanal quarter of the lesion. Histologically, this lesion consisted of a well differentiated adenocarcinoma. A study of lymph nodes showed no metastasis. These pathological findings indicated that this case was the typical Ⅱc＋Ⅱa type early gastric cancer having the biphasic growth described by Sano.

　We correctly diagnosed this case of widespread Ⅱc＋Ⅱa type early gastric cancer before operation.