Ⅱb型早期胃癌とATP（隆起・陥凹）合併例

A CASE OF Ⅱb TYPE EARLY GASTRIC CANCER ASSOCIATED WITH ATP (PROTRUSION AND DEPRESSION)

はじめに

　筆者らは，集検によってチェックされ，胃生検によって癌と確診された，Ⅱb型早期胃癌で，微小Ⅱa様異型上皮巣と，微小Ⅱc様異型上皮巣を合併した症例を経験したので報告する．

　Case: a 49-year-old male.

　In a gastric mass survey he was found to have at the gastric angle a protrusion, later confirmed as of cancer by biopsy. It was (1) Ⅱb type early gastric cancer, associated with (2) minute Ⅱa-like nests of atypical epithelium as well as with (3) minute Ⅱc-like aggregates of the same kind of epithelium.

　Located at the gastric angle a little toward the posterior wall, the first lesion, measuring 4.5 by 2.5 cm, was of rough surface, a little discolored and with its luster lost. Macroscopically the areae gastricae were indistinct. It was adenocarcinoma tubulare histologically with ‘m' degree of depth invasion. In the direct x-ray pictures was observed abrupt cessation of the mucosal folds converging toward the lesion with small fleck-like shadows scattered around in the center. These were hard to visualize and to interprete. Endoscopically the lesion was suspicious of cancer because of white exudate of irregular shape, engorgement and rough and uneven surface, but exact diagnosis was possible only by biopsy.

　The second lesion, measuring 7 by 6mm, was located on the anterior wall a little distal from the first, being observed as a Ⅱa-like protrusion.

　The third, Ⅱc-like depression, was observed at a site more posterior to the first lesion. It had a starry shape measuring 10 by 10mm. ATP in this type of depression, seldom encountered, has a close resemblance to minute Ⅱc type early gastric cancer unaccompanied with ulcer.