術前にⅡc型早期癌と診断されたpm胃癌の1例

Gastric Cancer Invading Proper Muscle of Which Preoperative Diagnosis Was Early Cancer of Type Ⅱc (m), Report of a Case

　近年，胃癌に対する胃X線・内視鏡診断技術の進歩は著しく，その深達度の推定についてもルーチンワークとして行われている．しかしながら，深達度診断のうち，特に陥凹型胃癌の早期癌と早期胃癌類似進行癌との鑑別にはしばしば難しいものが存在する．

　そこで深達度に関して，術前診断と手術後の病理組織診断とが食い違った症例のうち，見直し診断をしても，なお診断が難しかったⅡc型早期癌類似進行胃癌の1例を供覧し，現在の胃癌の深達度診断における問題点について若干の検討を加えた．

　A 25-year-old woman patient was referred to our hospital with a tentative diagnosis of a suspected gastric cancer. The preoperative stomach x-ray and gastrocamera examinations gave the diagnosis of Ⅱc type gastric cancer of which invasion was limited to the mucosa. Histopathologic examination of the surgical specimen, however, revealed that the carcinoma had massively involved submucosa (sm) in the depressed area and partially penetrated the proper muscle layer (pm). The final histologic type of the case presented was poorly differentiated adenocarcinoma. It was very difficult to give this patient the diagnosis of pm cancer even after taking into consideration the conventional finding of vertical invasion.

　Recently we endoscopically reviewed cases of Ⅱc type early cancer and Ⅱc-like advanced cancer encountered in the past five years. In 25% of the cases it was difficult to determine the depth of invasion.

　On the other hand, considering the recent change of macroscopic findings of early gastric cancers, unusual type of early cancers (gastritis-like cancer) are markedly increasing in recent years. The fact indicates that it is important to establish new criteria for diagnosis of the invasion.