術前に深達度をsmと診断し，組織的にもsmであったⅡc型早期胃癌の1例

Early Gastric Cancer, Type Ⅱc, Preoperatively Estimated as sm in Its Depth Invasion and Histologically Proved as Such, Report of a Case

　術前に深達度をsmと診断し，組織的にもsmであったⅡc型早期胃癌の1例を報告する．

症例

　患　者：62歳，男，会社経営．

　主　訴：空腹時心窩部痛．

　家族歴：特記すべきものなし．

　既往歴：50歳時痔核手術．

　現病歴：1967年以来，某診療所の逐年検診を受けていたが，異常を指摘されなかった．1978年4月末ごろ，空腹時心窩部痛が出現したため，同診療所の胃X線検査および内視鏡検査を受け，幽門前庭部後壁大彎側寄りのⅡc＋Ⅲ型早期癌と診断された．生検組織診断は，管状腺癌であった．同年7月27日，癌研内科に入院した．

　A 62-year-old man complaining of hunger pain in the epigastrium was diagnosed preoperatively by both x-ray and endoscopy as having Ⅱc type early gastric cancer with its depth invasion reaching sm. The area of sm infiltration estimated by x-ray examination did not coincide with the area of infiltration proved histologically. Radical gastrectomy (R₂: N₀H₀P₀S₀) was performed at the Surgical Department, Cancer Institute Hospital, Tokyo. The size of the lesion was 30×25 mm. Histologically it was differentiated tubular adenocarcinoma. Intestinal metaplasia of the mucosa around the lesion was of high degree. When compared with histological specimens, sm infiltration was seen by x-ray on the greater curvature side of mucosal convergency as revealed by prone compression study with a small amount of contrast medium. Situated as it was in the center of the depressed area, sm infiltration did not coincide with the area of coarse radiolucency. What was considered as protruded area caused by submucosal infiltration displayed thick fibrous hyperplasia reactively produced by ulcer. Endoscopic picture showed triple contours consisting of reddening, white coat and pooling of dye spread there. Our diagnosis of sm cancer in the central part of the lesion proved correct. On reflection of our roentgenologic diagnosis, the area of sm infiltration was localized in the center of the lesion, measuring about one third of the whole lesion in the greatest diameter. Submucosal infiltration was also not so dense. Roentgenographically we should have thought of more extensive or more appropriately graded compression method since there was striking fibrous hyperplasia accompanying ulcer in the submuccsal layer.