大彎側やや後壁Ⅱc型早期胃癌の1例

A CASE OF TYPE Ⅱc EARLY GASTRIC CANCER ON THE GREATER CURCATURE

Ⅰ．はじめに

　大彎側微小病変の発見および微細所見の観察はレ線，内視鏡および生検検査の上でそれぞれ容易，あるいは困難であると論ぜられている．私は最近，胃体下部大彎やや後壁に位置する大きさ1.1×0.8cmのⅡc型早期胃癌を経験したので，その諸検査所見および病理組織学的所見を供覧しレ線，内視鏡の生検所見について検討を加え報告する．

　Patient: T. T., female, 44 years of age.

　Main complaint: pain below the heart.

　Present condition: The pain persisted since about 1964.

　X-ray observation: Though barium-filled picture of the standing position revealed no particular change, double contrast method was successful in bringing out an irregular depression toward the posterior wall of the greater curvature. Since the convergence of mucosal folds was quite notable, along with their interruption, curving hypertrophy at the tip of folds, fusion of several of them, abrupt disappearance, and spotted appearance, the existence of Type Ⅱc cancer in the margin of the ulcerous change was strongly suspected.

　Endoscope observation: A small ulcer with convergence of mucosal folds was detected on the greater curvature of the lower gastric corpus. Its appearance greatly coincided with X-ray obser vation. Protuberance in the margin, fusion of several mucosal folds at the tips, and club-shaped swelling were causes enough for the examiners to suspect malignant ulcer.

　The result of biopsy: From the cellular tissue taken from the bottom of the ulcer adenocar cinoma tubulare was found.

　Gross observation of the excised stomach: On the greater curvature of the lower gastric corpus, and toward the posterior wall, a shallow and irregular-shaped ulcer was detected, the size of 1.1×0.8mm. The condition of the marginal area and X-ray the folds practically coincided with the results of and endoscope observations.

　Pathological and histological observations: Tubular adenocarcinoma accompanied by submucosal change, along with Type U1-Ⅱ ulcer.

　Thus, this was a case in which observations by X-ray, endoscope and resected specimen coincided to a greal extent. The Type Ⅱc early cancer was, though limited to a small region, deep penetrating, and it was accompanied by notable convergence of mucosal folds. This case satisfied the morphological and patholo-histological characteristics of malignant erosion defined by Otsuki.