深達度診断を誤った小さな隆起型胃癌（Borrmann1型）の1例

A Borrmann Type 1 Gastric Cancer Misdiagnosed in Its Depth of Invasion, Report of a Case

　深達度診断を誤った小さな隆起型胃癌（Borrmann1型）の1例を報告する．

症例

　患　者：46歳，男，会社員．

　主　訴：自覚症状なし．

　家族歴：同胞11人中4人が胃癌で死亡．

　既往歴：41歳時虫垂炎手術．45歳時発作性心房細動．

　現病歴：同胞に胃癌が多いため，1973年某病院にて胃X線検査を受けたが，そのときは胃炎と診断された．その後も胃X線検査を受けていたが，1975年10月26日近医での胃X線検査でⅠ型早期癌と診断された．同年12月3日癌研内科に入院した．

　The patient was a 46-year-old man with no particular complaints. Preoperatively he was diagnosed as having Ⅱa type early gastric cancer with m invasion depth, but after the operation histological study demonstrated that cancer invaded the submucosal layer like a mass. Roentgenographycally, a line of slightly irregular contours, measuring 15×13 mm, was seen on the lesser curvature of the mid-body. On its surface was recognized a small, pale shadow fleck. Endoscopy revealed that this protruded lesion was rather flat and its margins were mostly smooth, but it was raised relatively sharply from the base. The tip of the lesion was easy to bleed. By both x-ray and endoscopy the lesion was diagnosed as Ⅱa type early cancer and the depth of invasion was estimated as m. Radical operation: R₂ (N₀H₀P₀S₀) was performed at the Department of Surgery, Cancer Institute Hospital, Tokyo. The resected specimen showed an almost round and flat elevation, measuring 15×13 mm, on the lesser curvature of the mid-body. The contours were slightly irregular with faintly reddened surface. There was no ulcer. The mucosal surface of the protrusion hardly differed from that of the surrounding mucosa. Histologically the lesion was adenocarcinoma papillotubulare, consisting of Ⅱa-like hyperplasia of cancer within the mucosa and massive infiltration in the submucosa. Re-investigation of the x-ray findings before the operation comparing with those of histologic specimens showed us a translucent area coinciding with that of deep infiltration in a film which depicted the lesion as a side view. Accordingly, we have realized the importance of side view of a lesion when we attempt to estimate the depth of infiltration in protruding lesions.