Ⅲ型早期胃癌症例

Six Cases of Type Ⅲ Early Gastric Cancer

　早期胃癌の肉眼型Ⅲについては，種々の論議があるが，ここでは病変の肉眼形態を一応Ⅲ型としてもよいと思われる症例を示すことにした．

　九大第2外科で，昭和35年から同45年までの11年間に手術された早期胃癌134例（140病変）のうち，Ⅲ型早期胃癌に相当するものは6例で，早期胃癌病変の4.3％であった（表1）．この6例のⅢ型早期胃癌症例を表2に示したが，この表中の2例（症例5，6）を供覧する．

　There are still arguments for and against the existence of type Ⅲ early gastric cancer as a pathological entity. When examined in detail, the type Ⅲ has more or less Ⅱc lesions on its margins, so that, strictly speaking, it seems to be no other than type Ⅲ＋Ⅱc in its gross morphology. However, there are some cases in which Ⅱc lesion around type Ⅲ is not so apparent. For the time being, we have grouped into type Ⅲ those early cancers that have cancer lesion around the margins of Ul-Ⅳ ulcers with either indistinct or otherwise minute Ⅱc lesion when examined in the gross specimens of the removed stomach.

　During the years 1960 through 1970 we have come across 134 cases (140 lesions) of early gastric cancer at the Second Department of Surgery, Kyushu University. Of these, six might be classified into the type Ⅲ early cancer. Details of diagnoses in these cases have been tabulated here, and two most representative cases have been demonstrated with their x-ray and endoscopy pictures together with their resected specimens as well as histological findings.

　Of six cases, four were diagnosed either as cancer or cancer suspect by x-ray examination. Endoscopy was also of great help as three out of five were thereby confirmed as cancer. Cytological diagnosis had the desired effect only in one out of four. It was diagnosed as class Ⅴ. The overall preoperative diagnosis was correct in five out of six, but macroscopic diagnosis of the removed stomachs was gastric ulcer likewise in five out of six, thus exemplifying difficulties in the gross confirmation of type Ⅲ early gastric cancer.

　Three patients survived the surgical operations more than five years; one succumbed after six years and eleven months owing to cancer recurrence in the gastric remnant, and the other two each died from an accident and a disease other than cancer.