広汎な表層拡大型を示した類似Ⅱb型早期胃癌

A IIb Subtype Early Cancer of the Stomach Showing Superficial Spreading Type of Great Extent, a Case Report

症　例

　患　者：小○シカ○　63歳　女性

　主　訴：軽度の腹部膨満感

　既往歴：糖尿病があり，毎日レンテインスリン16単位ずつ注射を受けている．

　家族歴：特記すべきことはない．

　現病歴：約2カ月前から食後軽度の腹部膨満感を覚えるようになった．すなわち，食物が胃につかえた感じで，空腹感が少ないような感じがするようになった．しかし，食物は食べればおいしいし，従来と変わらぬぐらいの量を食べていた．約40日前近所の内科で胃透視を受け，胃角部の硬化を指摘され，精密検査のため当院を受診した．

　X-ray examination of the stomach of a 63-year-old woman revealed widening of the gastric angle. Rigidity of the gastric contour was also extensively observed along both curvatures at the level of the angle. Double contrast study disclosed an extensive area, centering on the angle, whose areae gastricae were either enlarged and rough or indistinct. The border of the pathologic area was ill-defined, however.

　Endoscopy of the stomach showed slight unevenness of the mucosal surface on the lesser curvature in the angle region together with minor degree of mucosal reddening. A stretch of rough mucosa was widely seen not only on the oral and posterior wall side of it but also on the distal side. Some part of it looked velvety as if the areae gastricae had atrophied or even disappeared. Tubular adenocarcinoma was finally detected by the biopsy of the angle region, followed by gastrectomy.

　Gross observation of the resected stomach showed an extensive lesion, measuring 8.0×9.0 cm, surrounding the lesser curvature of the angle slightly on the side of the posterior wall. The diseased area was of rough surface with disorderly arrangement of the areae gastricae, in some parts with their complete erosion. A part of the lesion was slightly elevated, but as a whole the surface was nearly flat. Histologic examination revealed highly differentiated tubular adenocarcinoma entirely localized within the mucosa, showing the so-called superficial spreading type of gastric cancer. Diagnosis of a flat type of gastric cancer as seen in our case is confronted with difficulties in both x-ray and endoscopy. The present findings are of great interest as they seem to afford us some clue to the diagnosis of typical IIb subtype early cancer of the stomach to be established in future.