症例7 26歳（♂）の早期胃癌

A Case of Early Gastric Cancer in a 26-Year-Old Male

　患　者：宅○美○仁　26歳　男　バンドマン

　家族歴：特記すべきものなし，

　現病歴：昭和45年11月25日から翌26日にかけて少量下血，28日朝に突然吐血（中等量）．某医にて胃潰瘍の診断のもとに入院治療中のところ，精査を希望し46年1月16日当院入院．

　現　在：特記すべきものなし．

　検査成績：初診時すでに貧血はなく，胃液酸度正酸，他の諸検査にも異常を認めない．

　A 26-year-old male patient was admitted to our hospital without complaints, who had an attack of profuse hematemesis and melena two months before and had been treated under a diagnosis of gastric ulcer in a clinic.

　On admission blood examination was normal without anemia and gastric juice showed 46 in total acidity and 28 in free hydrochloric acidity.

　Double contrast radiograph in prosition (Fig. 1) revealed a positive irregular-outlined fleck, 15 mm in diameter, on the anterior wall near the greater curvature of the angle. Several dim negative spots were seen on the fleck. It was surrounded by several converging mucosal folds, which were hypertrophic and irregular in shape and were disrupted at the margins of the fleck.

　Endoscopic examination with GTF-A disclosed a shallow depressed lesion, whose inner surface was not smooth but granular, and converging mucosal folds, which showed hypertrophy, fusion, disruption at the serpiginous margin and thinning inside the lesion; features characteristic of Ⅱc lesion (Fig. 3). Three of 4 biopsy specimens obtained at endoscopic examination were proved to have mucous carcinoma.

　The resected stomach (Fig. 4) had a depressed lesion,15 X 12 mm in size, at a distance of 70 mm from the pyloric ring, showing the same findings as observed at endoscopy. Histological study (Fig. 5) revealed a presence of cancerous tissue at the parts from No. 8 to No. 11, whose type was adenocarcinoma tubulare (CAT Ⅲ, SAT 3, INF γ) mucocellulare. The mucosal carcinoma invaded the submucosal layer in a region, where the mucosa was absent and lamina muscularis mucosae was broken, making a shallow ulcer.