比較的若年者にみられた胃体部前壁のⅡc症例

A Case of Type Ⅱc Early Gastric Cancer on the Anterior Wall of the Corpus Encountered in a Fairly Young Person

　Ⅰ．症例

　患　者：K. W.　29歳　♀．

　主　訴：心窩部痛．

　家族歴：特記することはない．

　既往歴：昭和42年6月頃から1日数回，食事と無関係の心窩部痛が起るようになり，その後，次第に心窩部痛が増強し，回数も増加してきた．昭和45年11月6日朝，列車内で悪心，意識混濁を起こし，某病院に入院．胃潰瘍と診断された，内科的療法を受けるも症状が軽快せず，昭和46年2月19日，当センターに入院した．

　A 29-year-old female patient had noticed since about June 1967 epigastric pain which became worse as the years went by. In February 1971 she visited our out-patient's clinic and was admitted.

　X-ray picture revealed a slight depression on the anterior wall of the middle corpus. Six mucosal folds converging toward the depression ceased abruptly near it. There was no picture of atrophic gastritis from the lower body down to the pyloric antrum. Endoscopy by means of GTF-A also disclosed similar findings as of x-ray.

　Since the patient was fairly young and atrophic gastritis could not be observed from the pylorus up to the lower body, the cancer lesion was considered a depressed one apparently arising from the fundic gland area. Moreover, the histrogical type of this lesion was assumed to be of undifferentiated one because of recent results in histopathological studies of many cases of early gastric cancer in Japan.

　Biopsy by FGS-BL confirmed our assumption as the lesion was undifferentiated adenocarcinoma tubulare consisting of signet ring cells. Our description of findings before the operation also coincided with that made after it. It was a Ⅱc with cancer infiltration limited within the mucosa, partly accompanied with erosions, Ul-Ⅱ. When the location and associating gastritis of early gastric cancer are taken into consideration, not only some of its histological types can now be preoperatively diagnosed but also their characteristics as well as their prognoses can be assumed to a certain degree. However, there still remains much to be studied whether the patient's complaint of over four-year's duration is due to a shallow ulcer or gastritis arising from the fundic gland area. Further evaluation of symptomatology in early gastric cancer shall be of great use in clarifying its pathological behavior.