前庭部早期胃癌の症例

A CASE OF EARLY GASTRIC CARCINOMA IN THE ANTRUM

Ⅰ．症例

　患者：53歳男

　家族歴：父，肺結核で死亡．母，80歳で老衰で死亡．弟，上顎癌手術後4年健在．

　既往歴：約30年前に虫垂切除術を受けた．昭和39年頃より腹痛のため2，3の病院を受診し検査をうけ，胆嚢が造影されないため胆嚢炎と診断されたが，胃の異常は指摘されなかった．

　現病歴：患者の弟が医師で，たまたま昭和42年10月に胃のX線検査を行ない，その結果につき相談をうけたが，前庭部に壁の異常をみとめたため精検をすすめ来院してもらった．その時の充盈像はFig. 1とほとんど同様であった．来院時には腹痛などの訴えはなく，かるい上腹部の不快感がある程度であった．

　A 53-year-old male suffering from occasional abdominal pain since three years ago consulted several clinics, where a diagnosis of cholecystitis was made because his gallbladder had not been visualized at all in cholecystograms. No abnormalities of the stomach were pointed out.

　The authors had an opportunity to examine the so-called negative X-ray films of the stomach previously taken, and found a deformity of the antrum. The lesion was then scrutinized by repeated X-ray and endoscopic examinations, to reach a diagnosis of early gastric carcinoma of the Type Ⅱc or Ⅱc+Ⅱa.

　On resection, the lesion proved to be early gastric carcinoma of the Type Ⅱc, 10×10 mm in size, located on the greater curvature 3.5cm away from the pyloric ring. Serial sectioning revealed carcinomatous infiltration limited to the mucosa and the submucosa. No lymphnode or distant metastasis was noted. The details of gross specimen were compared with X-ray and endoscopic findings. The patient also had cholelithiasis, evidently accounting for his symptoms. Gastric cancer was incidently found in this case.

　It has been well documented that even a small early gastric carcinoma as this case cause abnormality in the upright filling racliogram. The importance of upright filling, therefore, can not be overemphasized. For qualitative diagnosis, however, additional radiograms with different techniques such as double contrast study and compression method should be combined. Endoscopic examination seems also mandatory particularly for small lesions.

　It should be added that overlooking of lesions has been minimized in the authors' practice by means of group discussions.