瘢痕性粘膜ヒダ集中のために修飾されたⅡa＋Ⅱc型早期胃癌の1例

A Case of Ⅱa+Ⅱc Type Early Gastric Cancer Modified in its Shape by Cicatricial Mucosal Convergence

はじめに

　筆者らは，併存する粘膜ヒダ集中によって当初Ⅱcを疑い，生検所見からⅡaを疑ってX線精密検査を反復再検し，結局Ⅱa＋Ⅱcであった1例を経験したので報告する．

　A 53-year-old man having no symptom to complain of was found at a gastric mass survey done two and a half months before the operation to have an abnormal run of the mucosal folds on the posterior wall at the height of the angle, so that he was adrnitted to hospital for its exact evaluation. The patient was 166cm tall, weighing 68.5kg. Occult blood in the feces was negative. Gastric juice showed anacidity. After repeated x-ray examinations, a shallow depression of irregular shape was visualized on the posterior wall at the gastric angle by the double contrast method with medium amount of air. The depression was surrounded with mucosal convergence looking like petals of chrysanthemum. By the same method with smaller amount of air, the outer margins of chrysanthemum-flower-like protrusions were delineated as a shallow radiolucent area. The same finding was obtained by proportioned compression as well. In the study of endoscopic examinations done three times, surrounding areas of swollen mucosal convergence could be retrospectively inter preted as Ⅱa, but the overall findings were such that they were regarded as caused by sm type Ⅱc As biopsy under direct vision disclosed tubular adenocarcinoma as seen in Ⅱa, operation was done under a provisional diagnosis of Ⅱa+ⅡQ. Subsequently the lesion proved to be Ⅱa+Ⅱc (CAT Ⅰ, SAT 2). The area outside the Ⅱa was elevated because of the remaining fundic glands, while the central area was depressed owing to their disappearance. In the midst of this area was a linear erosion having a scar in its center slightly reaching underneath the lamina muscularis mucosae. Such a striking mucosal convergence caused by so slight a scar was regarded as the result of fibrinous hyperplasia in the submucosal layer.

　Belonging to those who consider that developmental pattern of cancer is different between Ⅱa and Ⅱc, the authors wish to lay stress on the necessity of minute examination of any elevated area around a depression even in such a case as this which looked at a first glance like a Ⅱc lesion.