重複Ⅱc型早期微小胃癌の1例

Multiple Ⅱc Type Early Microcarcinomas of the Stomach, a Case Report

　早期胃癌の診断が漸次微細な変化を問題とし，極く小さなⅡcや，Ⅱb型早期胃癌を診断する必要が大きく叫ばれている．筆者らは7×5mmと4×4mmのⅡc型早期微小胃癌の多発癌を経験したので報告する．

症例

　患　者：ハ○タ○子，44歳　女

　既往歴：特記事項なし．

　現病歴：5カ月前より心窩部痛および背部痛を訴え，某医を受診し胃X線検査・胃内視鏡検査の結果，胃潰瘍と診断され，2カ月間内科的治療をうける．しかし体重減少，胃部不快感を主訴として45年6月25日来院する．

　A report is made of small double early cancers of the stomach seen in a 44-year-old woman. The cancer on the posterior wall of the antrum measured 7×5 mm, and the other on the posterior wall in the lower body was 4×4 mm in size. The larger lesion was recognized both by x-ray and endoscopy as a well-defined, shallow and irregular depression of the mucosa. As the surrounding mucosa was protruded as in a Ⅱc lesion, this was diagnosed as Ⅱc. However, biopsy revealed atypical epithelial lesion belonging to Group Ⅱ. Consequently, we had to wait another six-months for further follow-up. In the interim x-ray and endoscopy examinations were done three times, the lesion remaining unchanged during that period. Malignancy was not confirmed until the third biopsy when materials were taken from the central portion of the depression.

　The other smaller lesion was not clear even on the resected specimen, and only histological examination disclosed the existence of malignancy. Retrospective interpretation of x-ray and endoscopy findings has revealed a very small, irregular depression or niche. This case seems to show that strict interpretation of roentgenograms obtained may lead to diagnosis of cancer even less than 5 mm in diameter.