症例1 20歳（♂）の早期胃癌

A Case Early Gastric Cancer in a 20-Year-Old Male

　患　者：20歳　男（昭和26年7月9日生）

　初　診：昭和46年9月23日

　主　訴：上腹部痛・胸やけ・悪心

　現病歴：約2年前より上腹部痛・胸やけ・悪心・曖気・体重減少などの症状が現われたため某病院に受診し胃潰瘍の診断を受け，服薬治療を続けていたが治癒しにくいため当院を訪れた．

　胃液検査所見　テトラガストリン法で高酸（最高遊離塩酸度104臨床単位）

The patient : a 20-year-old male.

The first examination : Sept. 23, 1971.

Chief complaints : pain in the upper abdomen, heartburn and nausea.

　Present illness : Since about two years before he had pain in upper abdomen, heartburn, nausea and belching, together with loss of weight. He had been under a medical managent in a hospital under a diagnosis of gastric ulcer, but as symptoms persisted, he came to our hospital. Gastric juice: hyperacidity (tetragastrine method), with maximum free hydrochloric acid 104 c1. U.

X-ray findings of the stomach : Deformity of the angle with rigidity of the contour was noticed in upright, barium-filled picture. A niche surrounded with a shallow depression was seen in prone, double contrast pictures, showing a so-called double outlined view. Mucosal folds converging toward the depression ceased on the outer margins of the depression. The tips of the folds, however, were hardly suggestive of findings peculiar to a Ⅱc.

Finding of endoscopy : An ulcer of irregular shape was seen at the agnulus in the posterior wall side. The mucosa anterior to the ulcer was uneven and rough with bleeding spots. Mucosal folds converging to the ulcer from the anterior wall ceased abruptly before reaching the lesion. Spot biopsy demonstratec adenocarcinoma tubulare in 6 biopsied specimens.

　Preoperative diagnosis was early gastric cancer, Ⅱc＋Ⅲ (sm ?). Gastric resection was done on Oct 15.

Histological findings : They revealed Ⅱc＋Ⅲ subtype mucosal cancer, measuring 2.1×3.2 cm, accompanied with Ul-Ⅳ ulcer at the angle. Histologically it way tubular adenocarcinoma.