集簇したⅡa様隆起と接した広汎なⅡc型早期癌

A Case of Extensive Ⅱc Type Early Gastric Cancer Adjacent to Groups of Ⅱa-like Protrusions

はじめに

　最近のX線，内視鏡による胃疾患の診断技術の向上はめざましく，表面平坦型Ⅱbに近い凹凸の少ない病変の発見についても，いくつかの報告がなされている．筆者らも最近，興味ある早期癌症例に遭遇し，2，3の知見を得たので報告する．

　Case: 70 years old male.

　He had no subjective symptoms except loss of weight (5 kg in 2 years) till Dec. 1968, when he underwent a gastric mass survey. Subsequent thorough examination revealed no particular abnormalities in the upright, barium-filled pictue (Fig.1).

　Mucosal study in the prone position (Fig.2) as well as the double contrast radiograph in the supine position with various amount of air (Fig. 3, 4 and 5) disclosed irregularity of the mucosal folds on the anterior and posterior walls of the angle and the lower body. A shallow depression with interrupted folds was also observed on the irregular mucosa of the posterior wall of the body.

　Endoscopic examination likewise revealed elevation of the mucosa of irregular shape at the gastricangle (Fig.6) together with a depression having interruption of the radiating folds on the posterior wall of the body (Fig.7).

　Of 8 sections of gastric biopsy available for study, malignant cells were demonstrated in 3 (Fig.9).

　Gross specimen showed superficial elevation of the mucosa at the angle (Ⅱa).

　adjacent to an extensive shallow depression on the large rough surface of the mucosa of the body (Ⅱc).

　Histologically there was revealed intramucosal and unfferentiated carcinoma of the stomach with no metastasis in the lymphnodes (Fig. 8, 9, 10).

　In this case, following points are interesting.

　1) The distension of the gastric wall by various amount of air or contrast medium is useful for the diagnosis of superficial type of early gastric cancer.

　2) Gastric biopsy is of use for the differential diagnosis and for determining the extent of cancerous invasion.

　3) Detection of the depression with interrupted radiating folds is of much account for the diagnosis of superficial type of early gastric cancer.