重複早期胃癌の1例―前庭部前壁のⅡa＋Ⅱcと胃角部後壁の微小Ⅱc

Double Early Cancer of the Stomach, a Case Report: a Ⅱa+Ⅱc on the anterior wall of the antrum and a minute Ⅱc on the posterior wall at the level of the gastric angle

　近年胃疾患診断学の進歩は目ざましく，胃癌ではより平坦なより小さな病巣の発見診断が課題となっている．筆者らは胃X線テレビ検査で発見し，X線精密検査，内視鏡検査，胃生検で確定診断し得た前庭部前壁の比較的小さな早期癌と，X線精密検査に仰臥位空気適量二重造影像で胃角部後壁に限局したarea異常を問題とし，Ⅱbの存在を疑って手術し，病理組織学的診断にて微小Ⅱcと確かめられた重複早期胃癌の1例を経験したので，X線像特に，二重造影像と切除胃標本とを対比させ，また本症例の微小胃癌の発見診断の動機となったarea異常としてX線描写されたⅡcと類Ⅱbの2症例の二重造影像も提示して，若干のX線像を中心とした考按を加えて報告する．

　A report is made of a case of double early cancers of the stomach along with correlation of their x-ray findings with the resected specimen. Initial x-ray TV with compression revealed on the anterior wall of the antrum a Ⅱa+Ⅱc, measuring 10×23 mm, that was later accurately diagnosed as cancer by minute x-ray examination, gastrocamera and biopsy. What was more important, localized abnormal areae gastricae were observed as well on the posterior wall at the angle. We performed gastrectomy with a strong suspicion of Ⅱb-like lesion there. Histologically it proved to be a minute Ⅱc, only 5×5 mm in dimensions.

　The Ⅱa+Ⅱc on the anterior wall of the antrum was well visualized by both prone compression study and prone double contrast. The other minute Ⅱc was demonstrated in x-ray films as localized abnormal areae in the supine double contrast study, when 150 ml of barium meal was ingested and about the same amount of air was introduced into the stomach. Cancer was demonstrated in the areas whose sulci were of irregular shape.

　Even the gross observation of the resected stomach failed to ascertain the extent of Ⅱa+Ⅱc on the anterior wall, and it was hardly possible to suspect the ex-istence of such a minute Ⅱc lesion on the posterior wall. The advantage the double contrast study has over the gross observation of the resected specimenis well exemplified in the present case. We can not be too cautious in picking up lesions in the stomach.