胃前庭部後壁のⅡa類似良性病変の1例

A CASE OF BENIGN LESION ON THE POSTERIOR WALL IN THE ANTRUM SIMULATING Ⅱa EARLY CANCER

Ⅰ．緒言

　最近肉眼的にⅡaまたはⅡaの疑いと診断されたものが病理組織学的に良性異型であったという例にしばしば遭遇するようになり，数年前よりそれらの鑑別診断が問題とされて来ている．著者らはⅡa類似の良性病変の1例を経験したのでここに報告する．

　Case: a merchant 66 years of age, male.

　Chief complaint: belching.

　Present history: Since the middle of January 1968 he would have bouts of belching with epigastric distress.

　X-ray findings: A mucosal convergence and a barium fleck were observed in double contrast study on the posterior wall of the gastric body. A shadow defect was also noted on the posterior wall of the antrum, suggesting of a localized swelling of the mucosal folds. Compression study brought out a radlolucency as of a loop hole in the antrum. Several thin barium flecks of irregular shape were observed in it.

　Gastrocamera study: Though seen as a distant view, an engorged, broadbased mucosal protuberance was noted on the posterior wall of the antrum.

　By these findings as demonstrated by x-ray and endoscopic examinations, operation was performed under a tentative diagnosis of a benign ulcer lesion on the posterior wall of the corpus and Ⅱa type early gastric cancer on the posterior wall of the antrum.

　Findings of the resected stomach: On the posterior wall of the corpus was seen an ulcer 6mm in diameter accompanied by mucosal convergence in addition to a mucosal protrusion 20 mm in diameter on the posterior wall in the antrum. Histopathologically the former was confirmed as a benign ulcer and the latter as an erosion.

　At present it is as yet next to impossible to differentiate such lesions from Ⅱa by macroscopical observation alone. Accumulation of such cases is therefore expected to contribute to the establishment of diagnostic criteria of Ⅱa type early gastric cancer.