術前に診断しえた重複微小胃癌症例

A Case of Double Minute Gastric Cancer Diagnosed before Operation

患　者：61歳男性

主　訴：特になし

既往歴：3年前に心窩部痛あるも検査は受けず．

現病歴：約1ヵ月半前に会社の定期検診（胃X線検査）にて胃の異常を指摘され，続いて胃内視鏡検査を受ける．これにより胃角上部前壁の隆起性病変と胃角部のビラン，胃体上部小彎の発赤が認められたため，約1カ月前に胃精査の目的にて当センターを受診する．外来の内視鏡検査（GF-BⅡ）で胃体．下部大彎前壁よりにⅡa様隆起と胃体中部大彎に1本の皺襞集中を伴う潰瘍瘢痕様病変が認められ，これらより生検を施行する．両病変ともに腺管腺癌が証明されたため当センターに入院する．

　The patient, a man aged 61 years, came to the present center for a close examination of the abnormality discovered in a routine medical check-up (gastric X-ray) at his office.

　Endoscopy at the out-patient clinic disclosed a Ⅱa-like protuberance on the anterior side of the greater curvature in the lower portion of the corpus, and a Ⅱb-like lesion, slightly elevated and reddish, at the end of a fold on the greater curvature in the middle portion of the corpus. Both lesions were cancerpositive in the simultaneously performed biopsy of the gross target areas.

　Histologically, these were well-differentiated adenocarcinomas with the m degree of penetration; one on the greater curvature in the lower corpus was Ⅱa-type the size of 5×4 mm, and that on the greater curvature in the middle corpus. Ⅱb-type the size of 10×6 mm 　Minute early gastric cancers smaller than 5mm in diameter discovered in the past ll years in the present center amount to 23 lesions in 21 cases (of which three were Ⅱa-type in gross appearance, 13 Ⅱb-type, six Ⅱc-type, and one Ⅲ-type). Histologically, these were all well-differentiated adenocarcinomas, and the degree of penetration was m in 96% of them. Of the above lesions, only 6 in 6 cases had been diagnosed preoperatively, of which two were Ⅱa-type in gross appearance, three Ⅱb-type, and one Ⅱc-type. In the said six lesions, two were diagnosed by X-ray, and three by gastroscopy for screening, while only one was identified by dye-staining method. Five lesions definitively diagnosed by biopsy had all been cancer-positive in the first specimens.