異型上皮を伴えるⅡa型早期胃癌の1例

A Case of Ⅱa Type Eearly Gastric Cancer Associated with Atypical Epithelium

Ⅰ．症例

　患者：S. H.　58歳　男　農業

　家族歴：父方の祖父が胃癌で死亡している．

　既往歴：53歳の時，胸膜炎に罹患している．

　Case: a 58-year-old male.

　Although having no gastrointestinal symptoms to complain of, the patient underwent a gastric mass survey in Jan 1967, when a shadow defect was found in the antrum Subsequently he was suspected by thorough check-up of harboring Ⅱc type early gastric cancer, so that he was admitted to Medical Dept of Prof. S Yamagata Tohoku University School of Medicine

　General clinical investigations revealed no abnormality at the time of admission. Roentgenologically, a deformity of the antrum, visualized by the filling method, was further clarified as a triangular radiolucency on the anterior wall of the antrum by means of double contrast study and compression method. In addition to this, a smaller, round shadow defect was noted in the lesser curvature side of the incisura.

　Endoscopy revealed broad-based protrusions both at the gastric angle and on the anterior wall of the antrum. The lesion at the incisura was almost of round shape, while that of the antrum was irregular in its contour. Both lesions were orsmooth and even surface, having no abnormal tinge as compared with adjacent areas.

　Cells of various sizes, as revealed by cytological diagnosis under direct view, contained nuclei of abnormal shapes as well as of different sizes. staining deeper than in normal cells, although the N/C ratio was not so great. Abnormal vacuoles were also noted in the cell body. Cancer cells were therefore concluded to be positive.

　The resected stomach showed on the anterior wall of the lower body a protruded lesion, shaped somewhat like a snowman, measuring 15 by 25 mm., in addition to a comma-like protuberance, 10 by 12 in diameters, located nearer to the lesser curvature.

　Histologically, the larger lesion on the anterior wall consisted of atypical epithelium, while the smaller one nearer to the lesser curvature was Ⅱa type early gastric cancer belonging to adenocarcinoma papillotubulare.