Ⅱc型多発早期胃癌の1症例

A CASE OF Ⅱc TYPE MULTICENTRIC EARLY GASTRIC CANCER

Ⅰ．はじめに

　われわれは最近高度のÉtat mamelonnéと数個の糜爛を伴った2個のⅡc型早期胃癌の症例を経験したので報告する．

　A man aged 65, having no previous history of gastric distress, underwent x-ray examination for screening because of positive occult blood in his stool. An irregular outline of the gastric contour was visualized then in addition to altered mucosal relief so that he was further studied by re-x-ray and endoscopy. Roentgenologically, an irregularly shaped radiolucency the size of a little-finger-tip, encircled by many small protrusions all about the size of a red bean, was observ ed in the lesser curvature side of the pyloric region. Endoscopy revealed, in the same site as observed by x-ray, a bleeding depressed lesion surrounded by nodular protrusions of various sizes varying from that of a red bean to a soya bean. This depression was diagnosed as IIc type early cancer. Final endoscopic examination further revealed besides this lesion another bleeding depres sion the size of a soya bean on the anterior wall in the antrum. Its nature could not be determined, however.

　Gross picture of the resected stomach was that of hyperplastic gastritis, the mucosa being in a state of "étate mamelonné", having five in all shallow depressed lesion. The depressed lesion in the pyloric region, measuring 20 by 10mm, of irregular polygonal shape, was encircled by large and coarse granulas. One of the typical IIc type cancer findings was exemplified in the color of the depression. It was pale white as compared with surrounding "état marnelonné". The other lesion in the antrurn,5mm in diameter, corresponding to what was observed in the final endoscopy, was surrounded by granular areae gastricae. It was hard to determine this lesion as cancer by macroscopic observation alone. Histological study revealed that both of these lesions were tubular adenocarcinomas, limited within the mucosal layer. The overall diagnosis was two independent early gastric cancers with the one in the lesser curvature side of the pylorus and the other on the anterior wall in the antrum. Lesions other than these two were not cancers but only shallow erosions.