Ⅱb型早期胃癌の1例

A Case of Ⅱb Subtype Early Gastric Cancer

　症例

　患　者：高○貞○，46歳，男．

　主　訴：自覚症状なし．

　既応ならびに家族歴：特記すべき事項なし．

　現病歴：1970年10月に当院が行なった会社の胃集検で異常を指摘され，精密検査を行なうことになった．健康には自信をもっていた．

　A Ⅱb subtype early gastric cancer, first checked simply as abnormal at a gastric mass survey, was preoperatively confirmed as such by biopsy in a man 46 years of age. He had no symptom to complain of, and the gastric juice showed hypoacidity. The lesion was of fairly large extent, measuring 4.5×6.0 cm, reaching from the anterior wall of the middle body over the lesser curvature on to the posterior wall. The resected specimen disclosed rough and large gastric areas of irregular shape, partly looking as if each of them had fused together. The borders of the lesion was indistinct. Histopathological specimen showed wide cancer infiltration into the middle stratum of the mucosa, partly intermixed with non-cancerous mucosa in several parts of the lesser curvature and posterior wall. The lesion was histologically carcinoma solidum simplex mucocellulare with m degree of depth invasion. No ulcer scar was recognized within it.

　X-ray characteristics that led us to the detection of early cancer were: very localized, abnormal marginal contour of the lesser curvature in the body; poor distensibility of the wall; and several thick linear shadows seen on the mucosal surface. In some places they were seen as short, double linear shadows. Endoscopically, we were prompted to the correct diagnosis by slightly reduced distensibility of the lesser curvature in the body and also by barely visible change in the mucosal hue. In short, these findings led us to biopsy and then to the correct diagnosis.

　In the diagnosis of Ⅱb subtype early gastric cancer, we believe that not only changes on the mucosal surface, but also those of the gastric contour and its altered distensibility should be fully taken into account.