胃大彎の小さいビラン型粘膜癌の1例

A CASE OF SMALL INTRAMUCOSAL GASTRIC CANCER OF ERROSIVE TYPE ON THE GREATER CURVATURE

症例

　患者：須○正○，74才，男．

　主訴：上腹部重圧感．

　既往歴：約10年前，大腸炎に罹つたほか著患を知らない．当病院を訪れる数カ月前から，上腹部の重圧感，げっぷ，咽頭部狭窄感，軽度食思不振を覚えるようになった．しこう品は煙草1日20本程度である．

　臨床諸検査成績：胃液は低酸を示し，下記X線所見および胃内視鏡所見のほか特記すべき異常所見はなかった．

　Although recent advances in and x-ray endoscope examination have greatly facilitated the diagnosis of early gastric cancer, report of Ⅱc type early carcinoma unaccompanied by scar formation is still few and far between, as this variety of cancer is usually attended by cicatrization around it.

　The case described in this paper is that of a 74 years old man, who has been complaining of feeling of fullness in the abdomen. At x-ray examination, a slightly altered silhouette of the greater curvature such as straightening of its contour was observed in the antrum in upright barium-filled picture as well as what seemed to be mucosal convergence in double contrast study. As was also confirmed by endoscopy, hyperplastic protuberances were prominent around the lesion, which was finally diagnosed as early gastric cancer after assiduous x-ray examinations and by endoscopic observations of dynamic changes in the mucosa as well as by biopsy. Prior to the surgical procedure, the lesion was regarded as belonging to Ⅱc accompanied by Ⅱa, but gross observation of the resected stomach betrayed the authors' anticipation; mucosal folds were certainly distorted, but nowhere was scar or mucosal convergence to be seen. Histologically it was a Ⅱc, with the size of 1.8×1.5cm unattended by cicatrization around it. Changes in the surrounding mucosa were those of marked hyperplastic gastritis associated with intestinal epithelization.

　Earliest possible detection of Ⅱc type early gastric cancer without concomitant scar formation is particlularly important, as it harbors the possibility of developing later into Borrmann Ⅱ type.

　Lesions on the greater curvature, as studied by x-ray and endoscope, are seen to best advantage when the stomach is in a slightly over-distended state. With due regard to characteristic features of mucosal patterns on the greater curvature, visualization of properly extended lesion is most desirable.

　Inasmuch as lesions on the greater curvature show a high rate of undergoing cancerous changes, this very small Ⅱc type cancer is reported here in detail.