吐血を主訴とする非定型的Ⅱc型早期胃癌の1例

ATYPICAL Ⅱc TYPE EARLY GASTRIC CANCER WITH VOMITING OF BLOOD AS CHIEF COMPLAINT

Ⅰ．はじめに

　Ⅱc型早期胃癌のなかにX線診断，内視鏡診断また切除胃の肉眼的診断において，良性糜爛か或いはⅡcとすべきか判定に困難を思わせる症例がある．かかる非定型的ともいうべきⅡc型早期胃癌の1例を経験したので報告する．

　A 42 years old female was referred to the authors’ hospital on Dec. 9, 1967, with blood vomiting as her chief complaint. She was anemic at the time of admission, the Sahli count being 50%.

　Symptomatic treatment was being carried on, X-ray and after her recovery, and endoscopic examination was performed. Roentgen films revealed a depressed lesion, suggesting Ⅱc or Ⅱc+Ⅲ type cancer on the posterior wall in the lesser curvature side of the lower gastric body. Endoscopic study brought out a lesion looking like a Ⅱc type carcinoma on the posterior wall in the gastric angle. Gastrectomy was accordingly performed on the 28th inst.

　Macroscopical observation of the resected stomach disclosed three converging mucosal folds toward the depressed lesion. One of these clearly showed abrupt tapering, while the other two seemed to have undergone little change, neither enlarged nor diminuished in size. On closer scrutiny, the depressed lesion itself was found to be divided in three small lesions of irregular shape. The margin of the depression was less clear-cut than is seen in the case of typical Ⅱc type lesion.

　The whole resected stomach was sectioned into 99 blocks, and these were studied in semi-serial sections. Patho-histologically the lesion was Ⅱc type early gastric cancer (mucosal). It was mostly carcinoma simlex mucocellulare and only a very small portion thereof was adenocarcinoma tubulare. The extent of pathological findings coincided with three irregular-shaped small lesions mentioned above.