Ⅲ＋Ⅱc型早期胃癌の1例

A CASE OF Ⅲ+Ⅱc TYPE EARLY GASTRIC CANCER

Ⅰ．緒言

　早期胃癌，特にⅢ型では，比較的大きい潰瘍の辺縁に小範囲の癌があっても，X線的に癌と診断することはかなり困難である．したがって術前に癌と診断するためには内視鏡的に経過を追うか，細胞診に成功した場合であろう．われわれは胃潰瘍と診断されて4年後に，Ⅲ＋Ⅱc型早期胃癌として手術した症例を経験したので報告する．

　A man 39 years of age with epigastric pain as his chief complaint was diagnosed as having ulcer carcinoma by x-ray. In barium-filled pictures, rigidity of the gastric wall at the incisura and above it was noted as well as broadening of the gastric angle. In double contrast study an ulcer of irregular shape with tapering-off and abrupt cessation of mucosal folds converging toward it was observed in addition to a round radiolucency which clearly visualized unevenness of the ulcer base. FGS study revealed a rough, broad ulcer of irregular shape at the incisura with its base covered with dirty coating. Toward the anterior wall was observed an engorged nodular protuberance and converging folds coming from the posterior wall became knobby at their tips. The overall diagnosis was Ⅲ+Ⅱc early gastric cancer. In the resected specimen a butterfly-shaped ulcer measuring 1.5 by 5.5 cm was seen extending from the anterior wall across the gastric angle over to the posterior wall. Histological examination revealed that the ulcer belonged to Ul-Ⅲ, and cancer cells were not found in the base of the ulcer but was in an area outside of regenerating epithelia on the slope around the ulcer. The submucosal layer was free from them.

　This case was treated as gastric ulcer at the incisura four years ago, but study of gastrocamera pictures taken at that time shows that already it was impossible even then to rule out cancer. Therefore, this case is considered as of ulcer carcinoma developed in the course of relapses in a recurrent ulcer of several years' standing.