ルーチンX線検査で拾い上げた類似Ⅱb型早期胃癌の1例

Type Ⅱb-like Early Gastric Cancer Detected by Routine X-ray Examination, Report of a Case

症例

患　者：40歳，男性．

主　訴：心窩部痛．

家族歴および既往歴：特記すべきことなし，

現病歴：1か月前から時々空腹時心窩部痛があり，当科外来を受診した．胃X線検査で異常を指摘され，内視鏡検査時，同部のびらんからの生検で胃癌と診断を受け，手術目的で入院した．

　A 40-year-old man was referred to our hospital because of epigastralgia. Routine barium meal study had shown coarse mucosal granularity near the lesser curvature on the supine double contrast view. An area of abnormal coating as well as rigidity of the gastric angulus highly suggestive of type IIb-like early gastric cancer was seen on the repeated x-ray examination. On gastroscopy, the mucosa of the antral and angular regions looked almost normal but fragile with a small erosion by dye-contrast method (lndigocarmine). Biopsy specimen taken from this erosion proved to include cancer cells and gastrectomy was carried out.

　In the resected specimen, there was a poorly delineated area of granular superficial mucosa with small erosions. Histological examination revealed 5.9×4.9 cm sized differentiated tubular adenocarcinoma limited to the mucosa.