2コの微小胃癌を有する多発性早期胃癌の1例

A Case of Multiple Early Gastric Cancer with Two Microcancers

　最近，胃疾患の診断技術の向上につれて，微小早期胃癌の報告も多くなってきた．しかし多発例の場合，術前に正確な診断を下すことはかなり困難となってくる．われわれは，7×7mmと1×4mmのⅡc型微小早期癌と，12×11mmのⅡa型早期癌の多発例を経験した．

　症　例

　患　者：56歳　男性(No. 605 '76)

　主　訴：胃部重圧感

　家族歴：特記すべきことなし

　既往歴：23歳の時，胸膜炎で薬物治療を受け治癒，46歳の時から高血圧症，不整脈で現在も薬物治療中である．

　現病歴：1976年6月頃から胃部重圧感が出現し，聖十字診療所を受診した．胃X線検査の結果，胃幽門前庭部小彎に異常陰影を指摘され，精査のため7月15日癌研外科に入院した．

　The patient, a 56-year-old man, visited this hospital in July 1976, with a complaint of gastric heaviness. X-ray and endoscopic examinations of the stomach revealed three lesions.

　Lesion No. 1 was a shallow depression with irregular margin, accompanying a linear ulcer in the lesser curvature of the antrum. Biopsy specimen showed the lesion to have Group 4. Lesion No. 2. was flat polypoid lesion in the greater curvature on the posterior wall of the antrum, with Group 3 as confirmed by biopsy. Lesion No. 3 was a linear depression towards the greater curvature on the posterior wall of the angle. Biopsy specimen showed it to be a differentiated tubular adenocarcinoma.

　The resected stomach was examined histologically after radical gastrectomy. Lesion No. 1 had an ulcer of Ul-Ⅱ and a stellar Ⅱc lesion of 7 X 7 mm on the greater curvature side. This was an early cancer of Ⅱc＋Ⅲ. Lesion No. 2 was a protruding lesion, with Group 3 in the majority, with a higher atypicality in a part, and this was determined as early cancer of Ⅱa. Lesion No. 3 was a differentiated tubular adenocarcinoma of 1 X 4 mm, localized within the mucosa, and determined as early cancer of Ⅱc.