症例2 21歳（♂）の早期胃癌

A Case of Early Gastric Cancer in a 21-Year-Old Male

　患　者：T. Y.　21歳　♂

　約2週間前より心窩部異常感を来たし，精査のため当成人病センターを受診した．

　家族歴：既往歴共に特記すべきことなく，臨床検査成績では胃液が高酸であるほか，血液検査および生化学検査ともに異常を認めなかった．

　胃X線検査では，立位像における胃角変形，辺縁不整像を認め，背臥位二重造影像における小彎の不整および浅い陥凹像，この陥凹内部は凹凸の変化を呈し，その部の圧迫像でも辺縁不整な陰影斑と，これに至る粘膜ひだの変化が明瞭であった．

　A 21 years old young man, compalining of abnormal sensation in the abdomen since two weeks before, consulted our clinic on June 23, 1971. Both family and past histories were not noteworthy. Laboratory examinations were within normal limits except for hyperacidity of the gastric juice.

　X-ray study of the stomach revealed an irregularity of the lesser curvature along the gastric angle in the upright barium-filled picture. Irregularity of the same site along with a shallow depression, extending to both walls, was also seen in the double contrast picture. Compression revealed there a barium fleck of irregular margins as well as changes in the converging mucosal folds.

　An uneven, broad and shallow depression was revealed by endoscopy, extending from the anterior to posterior wall. A white coat, suggesting of yet deeper excavation, was seen on the anterior wall. Mucosal folds converging to the depression from the anterior wall side showed fusion and abrupt cessation. It was diagnosed by gastric biopsy as carcinoma simplex mucocellulare. The operation was performed on July 14, 1971.

　Resected stomach showed a depressed lesion around the angle extending to both walls. It measured 53×15 mm, and its margins were irregular. The floor of the shallow depression was uneven and irregular, with another deeper depression, measuring 10×5 mm, in the center.

　It was confired by histology as carcinoma simplex mucocellulare, localized within the mucosa, its area coinciding to the shallow depression. Ul-Ⅱ ulcer formation was seen in the deeper depression with cell infiltration and fibrosis in the submucosal layer, but it was free from cancer invasion. Metastasis was found only in the sinus of a right cardiac lymph node.