術前に診断しえたⅡc型微小胃癌症例

A Minute Ⅱc Type Gastric Carcinoma Which Was Documented Preoperatively

　進行胃癌や他病変に併存する微小胃癌，あるいは多発の微小胃癌は，切除胃の組織学的検索に際し偶然発見されることが多く，このような微小癌は決して少なくはないが，術前に診断されて，手術された単発の微小癌はそう多くない．われわれは，5mm以下の大きさの単発の微小胃癌を，術前のX線検査，内視鏡検査で捕え，胃生検で胃癌と確診した症例を数例経験したので，その中の1例を供覧し，参考に供したい．

　Chief complaint: stomach discomfort

　Present illness: This 51 year old, female, housewife had been suffering from chronic gastritis for over the past four years. Because of the reason, she had had annual check up of the stomach. Upper G.I.X-ray examination and endoscopy of the stomach performed in July, 1976, revealed a tiny erosive lesion surrounded by the mucosal elevation. The pathologic examination of this lesion suggested the evidence of malignant change (group Ⅴ).

　The further examination of this lesion repeated after the admission, showed the findings of early cancer, gross type Ⅱa+Ⅱc. On the other hand the endoscopic examination disclosed gross type Ⅱc, and the repeated biopsy of the lesion showed gastric carcinoma. Gastric analysis showed normoacidity. On September, 24, 1976, gastrectomy with moderately extended dissection of regional lymphnodes (R 2) were performed.

　Operative findings: So, No, Ho, Po (No macroscopic infiltration to the serosal surface. No macroscopic metastasis to the liver, Iymphnodes, and peritoneum.) 　Pathologic findings: There was a reddish erosive lesion measuring 5×4mm in each diameter, which was surrounded by localized, irregularly shaped mucosal elevations. Microscopic examination revealed moderately-differentiated tubular adenocarcinoma localized within the macroscopic erosive lesion. It was mainly confined to the mucosal propria and focally infiltrated to the submucosal layer. INF: α, lyo, vo, n (-). Microscopic examination of surrounding mucosal elevations showed regenerative hyperplastic epithelium associated with stromal edema. This change may suggest the surrounding mucosal reaction to the tiny carcinoma. This surrounding mucosa] change might help to detect the minute carcinomatous lesion.

　Two cases of minute Ⅱc type carcinoma less than 5mm in the greatest diameter have been found in our hospital for past six years. (O.35% of all operated gastric carcinoma: 1.3% of all early gastric carcinoma.)