深達度診断を誤ったⅡa＋Ⅱc様進行胃癌の1例

Ⅱa+Ⅱc-like Advanced Gastric Cancer Erroneously Diagnosed in Its Depth of Invasion, Report of a Case

　深達度診断を誤ったⅡa＋Ⅱc様進行胃癌の1例を報告する.

　The patient was a man aged 20 with a chief complaint of dysphagia. Preoperatively he was diagnosed as having Ⅱa+Ⅱc type early cancer, measuring 18×16 mm, with sm depth invasion, located on the anterior wall of the mid-corpus in the side of the greater curvature. Histological study after the gastrectomy showed that it was advanced carcinoma with s depth invasion. X-ray films showed findings suggesting a submucosal tumor in the radiolucent area around the depression. Endoscopically it was diagnosed as advanced cancer, because wall-like changes remained around the depression despite the fact that white coat within the depression, recognized in films taken one month earlier, had disappeared. Radical gastrectomy (N₀H₀P₀S₀) was performed at the Department of Surgery, Cancer Institute Hospital, Tokyo. Histologically it was adenocarcinoma mucocellulare, its depth invasion reaching the serosa (s). The surrounding mucosa was that of the fundic glands. Elevation of the lesion was due to diffuse infiltration of cancer tissue into the submucosal layer and further deeper in almost the same extent as in the mucosa, showing striking proliferation of fibrous tissue accompanying cancer infiltration and hypertrophy of the submucosa and muscular coat. For estimating correctly the depth of cancer invasion in this patient we think that due consideration should have been paid to the analysis of roentgenographic and endoscopic findings.