症例4 22歳（♂）の早期胃癌

A Case of Early Gastric Cancer in a 22-Year-Old Male

　患　者：加○正○　22歳　男

　入院4カ月前より空腹時の心窩部痛とむねやけ出現．某病院で胃潰瘍と診断され加療されたが，腹痛が軽快しないのでと入院を希望．

　レ線所見　胃体中・下部小彎線は不規則で硬化し，胃角上部に小突出像が認められる（Fig. 1）．二重造影（Fig. 2）で，胃体下部小彎寄りに不整形の陰影斑と集中する口側粘膜皺襞の中断像が認められる．

　Case: M. K., 22-year-old male. Four months before admission he had noticed hunger pain in the pit of the stomach associated with heartburn. As the pain had persisted in spite of medical mangement under a diagnosis of gastriculcer, he came to our hospital.

　X-ray findings : The contour of the lesser curvature from the middle to lower body was irregular and rigid, with a small protrusion above the angle (Fig. 1). Double contrast picture (Fig. 2) showed a shadow fleck of irregular shape near the lesser curvature in the lower corpus corpus. Converging mucosal folds on the oral side ceased abruptly.

　Endoscopic findings (by GTF) : A shallow denression was seen on the lesser curvature of the lower body with several small ulcers within it. Mucosal folds converging towards it both the anterior and posterior wall were clearly interrupted on their ways (Fig. 3).

　Gross findings of the resected stomach : A shallow ulcer of irregular shape with uneven and rough floor, measuring 13 X 23 mm, was seen on the posterior wall in the lesser curature side. Abrupt cessation, fusion and thinning of the converging rugae were observed (Fig. 4).

　Histological findings : A shallow ulcer scar (Ul-Ⅳ) was seen in the neighborhood of the depression's center. Fairly well regenerated epithelia were partially seen. Cancer invasion, histologically adenocarcinoma tubulare mucocellulare, was recognized on both sides of the depression, but it was confined within the mucosa (Fig. 5).

　The patient enjoys gcod health five years after the operation. Incidentally, his father had also undergone operation of lung cancer at the age of 46 (a tiny tumor only 3 mm in diameter in the left B 10, histologically squamous cell carcinoma), and he is also in good health approximately ten years after the surgical intervention.