深達度診断に苦慮したⅡa＋Ⅱc型早期胃癌の1例

Early Gastric Cancer, Type Ⅱa+Ⅱc, Difficult to Differentiate from Borrmann Type 2 Advanced Cancer, Report of a Case

　中央陥凹と辺縁の環状に隆起するⅡa＋Ⅱc型早期胃癌は，ときとしてBorrmann 2型進行胃癌との深達度診断が困難な場合がある．われわれが深達度診断に苦慮したⅡa＋Ⅱc型早期胃癌の1例を報告する．

　The patient was a 75-year-old male employee of a company who was subjectively asymptomatic. Early in June 1978 he had stomach x-ray performed at his company clinic; as the result he was suspected to have abnormalities in his stomach. For thorough examination he was then referred to the Department of Internal Medicine of our hospital.

　Gastric x-ray revealed a lesion with central depression and elevated circular margins on the anterior wall of the antrum. The lesion was about 30×25 mm in diameter. Since, however, no irregularity of the wall of the antrum was noted on fluoroscopy by compression for the patient in a standing position, a diagnosis of Ⅱa+Ⅱc type early gastric cancer involving sm was made.

　Gastroscopy revealed a lesion on the anterior wall of the antrum as did the stomach x-ray. The mucosa adjacent to elevated circular margins was smooth and of the same color tint as the surrounding mucosa. The elevation of circular margins was assumed, therefore, to be the result of an upheaval of overlying layers by tumor cells that infiltrated beyond the submucosa. From the fact that the central depression of the lesion was relatively shallow and its margins were not so much elevated, a diagnosis of Ⅱa+Ⅱc type early gastric cancer involving sm was made and operation was performed.

　Histopathological examination confirmed the lesion to be a Ⅱa+Ⅱc type early gastric cancer with a depth of invasion of sm.

　The essentials in the differential diagnosis as to depth of invasion of Ⅱa+Ⅱc type early gastric cancer and Borrmann type 2 advanced gastric cancer are: (1) size, (2) appearance and height of elevated margins and (3) depth of depression. Even when due consideration was paid to these points the diagnosis as to the depth of invasion was difficult to make in the present case.