噴門部早期胃癌の1例

A CASE OF EARLY CARDIAC CANCER

Ⅰ．症例

　早期胃癌の報告は多いが，大部分のものが胃体部以下に存在するもので，噴門部早期胃癌の報告は少い．今回噴門部早期胃癌を経験したので供覧するとともに，現在迄に私共が経験した6例につき検討し報告する．

　患者：M. M.　62歳，男性．

　主訴：心窩部痛．

　The patient, sixty two years old male, had recurrent bouts of epigastric pain for three years running. In September 1967, he was referred to our hospital as he was found to have an ulcer on the posterior wall of the gastric corpus. Our X-ray study revealed an ulcer, partly cicatrized, in the above-mentioned region and a small excavation was visualized on the lesser curvature side of the gastric orifice. The border of this depression was partly indistinct, and it was surrounded by a slight, irregular elevation.

　By Vb-type gastrocamera, a linear excavation was seen to extend all the way from the anterior to the posterior wall on the lesser curvature side distal to the esophago-gastric junction. The lesion was erosive, partly bleeding, and its surface was uneven. It was confirmed, by biopsy, to be carcinoma adeno-tubulare, and our preoperative diagnosis was Ⅱc type gastric cancer.

　The resected specimen clearly shows Ⅱc type early gastric carcinoma, 0.7 cm by 2.2cm in size, 0.7 cm distal to the said junction. Two ulcer scars are found on the posterior wall near the incisura, in addition to five submucosal cysts located on the anterior wall of the corpus.

　In our Institute of Gastroenterology, there have been up to now six cases of early cardiac cancer. The percentage of its operations to all other operations in the cardiac region is 5.1%. Three out of six cases have been correctly diagnosed prior to the surgical exploration as early cardiac cancer. The fourth has been operated on as of gastric ulcer, the next being an emergency case of gastric hemorrhage. The sixth has been confirmed as such after the operation of esophageal carcinoma.

　The type of our six cases is as follows; one Ⅱa, one Ⅱb, three cases of Ⅱc, and one Ⅲ. Incidentally, three out of six are multiple carcinomas coexistent with esophageal cancer. One case has concomitant gastric ulcer, while another is accompanied by ulcer scars and submucosal cysts.