びまん性胃癌の早期像の診断上興味ある1例

Diffuse Infiltrative Carcinoma of the Stomach, Report of a Case

要旨　粘膜面癌巣よりはるかに広範なsm以下への深部浸潤を来したびまん性胃癌の比較的初期像と考えられる症例を経験し，そのX線所見，内視鏡所見，病理組織学的所見について検討した．本例では胃体中部前壁のレリーフ集中があまり明瞭ではない周辺隆起を有する浅いⅡc様陥凹が特徴的であり，深部浸潤の程度とその拡がりについてX線，内視鏡検査での診断は不十分であったが，びまん性胃癌の可能性を推察し，胃全摘術を施行した．

　A 39 year-old woman way admitted to the hospital due to hematemesis and tarry stool on November 21, 1980. Double contrast picture in the prone position revealed a Ⅱc-like shallow depressive lesion of irregular shape with surrounding edematous prominence and with slight converging folds on the anterior wall of the middle part of the gastric body. Endoscopic examination also revealed a shallow depression in the fundic gland area. Commonly, when a Ⅱc-like lesion is observed in the fundic gland area, cancer invasion to the submucosal layer occurs frequently and often shows a wide spreading. Consequently, total gastrectomy was performed on December 21, 1980. Resected specimen of the stomach showed a shallow depression, 7×6 mm in size, with slight converging folds on the anterior wall of the middle part of the gastric body. The gastric wall was not thickened and the folds and surface of the mucosa in the gastric body showed, except the Ⅱc-like lesion, no abnormality.

　Histological findings revealed that the mucosal invasion of signet-ring cell carcinoma was located in the depressed lesion only, while infiltration of cancer cells was more widely spread out in submucosal layer, muscularis propria and subserosa in the major part of the anterior wall of fundic gland area. Histologically, it was diagnosed as a relativ elyearly stage of diffuse infiltrative carcinoma of the stomach (H₀P₀s₁n₀v(-)ly(-) stage Ⅰ).

　The patient is still alive and active four years and one months after operation. In this case, the shallow Ⅱc-like depression with surrounding prominence on the fundic gland area was characteristic; however, the diagnosis for the grade of cancer invasion and for the range of spreading of cancer cells is not yet sufficient in radiological and endoscopical findings and by the palpation of the gastric wall during the operation. As in this case, when the possibilities of diffuse infiltrative carcinoma of the stomach is suspetted, total gastrectomy is most reasonable in obtaining good results.