sm癌と正診しえたⅡc型早期胃癌の1例

Early Gastric Cancer with Submucosal Involvement Estimated Correctly by “an Irregularity of Fine Granular Appearances within Type Ⅱc Lesion”, Report of a Case

　早期胃癌の術前診断において，sm癌とm癌とを確実な精度をもって鑑別することは，その予後を考えるとき，極めて重要なことである．われわれは日常，Ⅱc型早期胃癌（含Ⅱc＋Ⅲ型）において，陥凹周囲の所見のみならず，陥凹内部の微細な顆粒像に着目し，sm浸潤の有無を診断している．ここに陥凹内部の顆粒像の不揃い所見から，sm癌と正診しえたⅡc型早期胃癌の1例を提示し，若干の考察を加え報告する．

　A 68-year-old man with complaint of epigastralgia two～three hours after meal was admitted to the National Cancer Center Hospital for the exact examination of the gastric lesion, on April 7, 1977.

　With precise roentgenographic and endoscopic observations, an irregular shallow depressed lesion with converging folds was noted on the posterior wall toward the angle of the stomach, and irregular fine granular appearances within the lesion. It was considered as early gastric cancer, type Ⅱc, with the depth of invasion to submucosa. A partial gastrectomy was performed on July 8, 1977. Macroscopic findings showed early gastric cancer type Ⅱc.

　Histological appearance of the specimen revealed a signet-ring cell carcinoma with shallow invasion as deep as to the submucosa.

　Observed on the surrounding findings of Ⅱc lesion, this was considered as m cancer, but on the irregularity of fine granular appearances within it, this could be diagnosed as sm cancer.

　Therefore, for the diagnosis of type Ⅱc (including Ⅱc+Ⅲ sm cancer, it is important to make precise observation not only to the surrounding findings of Ⅱc lesion but also to the irregularity of fine granular appearances within it.