大彎側の表面陥凹型早期胃癌の1例

A CASE OF EARLY GASTRIC CANCER OF DEPRESSED TYPE ON THE GREATER CURVATURE OF THE STOMACH

Ⅰ．はじめに

　現在，胃疾患に関する診断技術の進歩は著しいものがあるが，胃の大彎側病変に関しては，前壁と同様その存在診断及び微細診断は容易でない．われわれは，この度大彎側の比較的小さい表面陥凹型（Ⅱc型）早期胃癌症例に遭遇したので，ここにそのX線像，内視鏡所見及び病理組織学的所見を供覧し，あわせて大彎側病変について2，3の検討を加えたので，報告する．

　A 32 years old male was hospitalized because of pain in the epigastrium. In the initial X-ray study, only mucosal convergence was revealed in double contrast view along the greater curvature opposite the gastric angle. Subsequent endoscopic examination visualized shallow depression with relatively clear demarcation as well as abrupt cessation mucosal folds around it. This was highly suggestive of Ⅱc Type early gastric cancer. Tips of interrupted folds were not clearly seen because they were too far endoscopically. Following double contrast study with larger amount of air well delineated abrupt cessation of mucosal folds with stair-like tapering around the lesion as well as marked unevenness in the center of indentation. It was a clear sign of Ⅱc Type early gastric cancer. The site of the lesion in the resected stomach fairly corresponded with that confirmed by the X-ray study. Macroscopically the lesion showed an uneven depression measuring 13 mm in diameter located in the greater curvature side at the height of the gastric angle. Its floor was rough, with marked convergence of mucosal folds and their abrupt cessation around it. Pathohistologically it was carcinoma simplex mucocellulare CAT Ⅱ, SAT Ⅲ, limited to the submucosal layer. An ulcer scar was also seen in the center of the lesion.

　The diagnosis of early gastric cancer in this case was greatly facilitated in double contrast study by marked mucosal convergence due to co-existent cicatrized ulcer. Otherwise it might have been very difficult. Together with re-recognition of the excellence of double contrast method in the diagnosis of early gastric cancer, importance is especially emphasized of correctly interpreting any abnormality, even of the slightest, of the contour of the greater curvature in barium-filled stomach.