内視鏡的生検により診断しえた微小胃癌の1例―組織学的には2つの分化型管状腺癌

A Case Report of a Minute Gastric Cancer Diagnosed before Operation

　直径10mm以下のいわゆる微小胃癌が1969年の第7回日本消化器内視鏡学会で討議されて以来多数の報告例とその検討がなされ種々の興味ある問題を提起しているが，臨床的には診断可能な限界の問題を，病理学的には胃癌の組織発生の問題を提起している．これらの問題点をふまえて胃内視鏡生検にて術前診断しえた5×4.5mmの1微小胃癌例について若干の考察を加え報告する．

　In June 1975 a 56 year-old man visited our clinical service complaining of nausea and epigastralgia. By X-ray examination kissing ulcer was found at the posterior and anterior wall of the gastric body. Though he had medical treatments. ulcers became worse. So he was admitted to our hospital. Beside the kissing ulcer of the body, a very small retracted area was found at the prepylorus by the endoscopic examination. Suspecting of Ⅱc early gastric cancer, 4 pieces of biopsy were available. In the former 2 pieces of biopsy tissue tubular adenocarcinoma was discovered. Under the diagnosis of Ⅱc early gastric cancer the subtotal resection of the stomach was performed in July 1975.

　The resected gastric specimen was sectioned carefully, mainly about the antrum. Especially the lesion of the erosion at the antrum was sectioned continuously about 12 mm. The result were CATII, SAT 2, INF α, m, lyoo,Voo, n (-) 0/17, 5×4mm in diameter well differentiated tubular adenocarcinoma, second independent minute focus of tubular adenocarcinoma in adjacent mucosa and benign Ul-Ⅲ kissing ulcer. Recently many minute gastric cancers have been reported, but the preoperative diagnosing is diffcult Through this case we learned the followings. Clinically minute gastric cancers are often associated with other lesions such as ulcers, so it is necessary to research another lesions satisfying not only one lesion. In biopsy it is important to target the lesion correctly at first. Pathologically this case indicates the hypothesis by Nakamura that differentiated carcinoma can arises from intestinal metaplasia.