拡大観察により特異な所見が得られたⅡb型早期胃癌の1例

A Type Ⅱb Early Gastric Cancer Which Showed Specific Findings in Magnified Roentgenogram

　胃癌のX線診断は病変の辺縁像，粘膜皺襞の先端の所見などが性状診断の主要な決め手である．しかしⅡb型早期胃癌は周囲の非癌部との間に明らかな高低の差がないため，辺縁像や皺襞の変化による読影は困難であり，そのため癌粘膜表面の所見を読影することが必要と考えられる．今回われわれは胃X線検査で造影剤の付着異常を指摘できるのみで，癌との診断はできなかったが術後のレントゲノグラムの拡大観察により微細な異常所見を指摘でき，拡大撮影が診断への手掛かりになると思われる症例を経験したので報告する．

　A 56-year-old man was admitted for the operation of the stomach. At first abnormality of stomach was picked by a mass survey. But by endoscopy abnormality was discovered at another portion. Microscopic examination of biopsy specimen established its lesion as cancer. X-ray films of detailed upper G.I. series revealed only abnormal adhesion of barium on the lesser curvature of the lower body. Endoscopic finding was only a small smooth elevation. Therefore by means of these examinations, diagnosis of cancer were not able to be made definitely. In the resected specimen obvious abnormal findings were not pointed out macroscopically. In the lesser curvature of the body, coarse mucosa was recognized retrospectively. Microscopically the cancer measured 15×22mm and was located in the mucosal layer. A cross section of the lesion showed an almost flat lesion. Histological type was moderately differentiated adenocarcinoma. Magnified (X4) roentgenogram of the resected stomach showed fine granular pattern in areae gastricae. It seems that this finding is a clue to the diagnosis of differentiated type of early Ⅱb cancer.