極く微細なⅡc型早期胃癌

ONE CASE OF VERY SMALL Ⅱc TYPE EARLY GASTRIC CANCER.

Ⅰ．はじめに

　われわれは最近，胃前庭部大彎の微細なⅡcを経験したが，その病巣から約3cm離れた幽門側後壁に，術前診断の不可能であった極く微細なⅡcの合併例をえたので報告する．

　なお，このように術前診断が不可能で，切除胃で漸く癌性変化を認めた極く微細なⅡc症例が，このほか2例あり追加する．

　The patient was fifty years old male. He was admitted here because he had a kissing ulcer at the lower part of the corpus. Then a Ⅱc on the greater curvature of the antrum was found and close examination was performed. Among various methods used for the x-ray examination, the compression method revealed the most precise figure. The small excavation and the long, narrow protrusion were seen on x-ray films. By the endoscopic examination, the irregular excavation with white fur and the gathering of the gastric folds were noticed. The biopsy performed by c-type fiberscope revealed Cl.-Ⅳ. The operation was done under the diagnosis of Ⅱc+Kissing ulcer. The scarred kissing ulcer at the mid part of the lesser curvature (1), the irregular, slender and shallow excavation with the obscure margin, 5×17 mm in size (2) and another very shallow, irregular excavation 6×4 mm in size on the posterior wall of the pylorus (3) were noticed on the operated specimen. Histologically, (1) was Ul-Ⅳ, Ⅲ type scar, and (2) ＆ (3) were both carcinoma adenotubulare which were located at each of the excavations, and the size of carcinomas were 5×24 mm (2) and 6×4 mm (3). The muscularis mucosae became partly thick and the slight fibrinization was noticed in the submucous layer in the carcinom (2). N0 such findings were noticed in the carcinoma (3). There have been two cases of Ⅱc which were found at the time of operation, like this instance. These two cases were not diagnosed as Ⅱc before the operation. The improvement of the method for diagnosing these cases is expected.