Ⅰ型とⅡc型の多発早期胃癌の1例

A Case of Multiple Gastric Cancer, Type Ⅰ with Ⅱc

　最近，多発早期胃癌の報告がさかんとなってきた．多発早期胃癌の術前診断はむずかしいと言われ，本症例でも術前Ⅰ型のみの単発早期胃癌として手術し，他の部位にⅡc型早期胃癌を発見したものである．

　The patient, a 69-year-old man, had epigastric distress of four months' duration. At the x-ray examination done by his physician, deformity of the gastric contour was noticed, so that he was referred for its exact evaluation. He was admitted to hospital because malignant transformation of gastric polyp was suspected by both x-ray and endoscopic examinations. At the time of admission, the patient, in moderate nutritional condition and of average physique, showed hypertention, the blood pressure measuring 180/100. No lymph node in the supraclavicular area was palpated. The abdomen, flat and non-resistant, had no trace of tangible tumor. The erythrocyte count in peripheral blood was 3.6 million per cu. mm., and Hb was 9.7g/dl. Tests for urine and liver functions remained within normal limits. Occult blood in the feces was positive. Hypertrophy of the left heart ventricle was noted by both x-ray and electrocar-diogram.

　X-ray examination of the stomach revealed deformity of its contour, centering on the incisura. A radiolucency was also seen in the pyloric antrurn, visualized as a protruding lesion of uneven and irregular surface by both double contrast and compression methods. Endoscopy also revealed a protrusion in the pyrolic antrum on its anterior wall in the lesser curvature side. This was duly diagnosed as early gastric cancer of type I. Besides this polypoid protruding lesion, a IIc-like depression was found in the course of surgical in tervention on the greater curvature of the lower corpus. Accordingly, subtotal gastrectomy was carried out. Pathologically, the top of the protrusion proved to be early cancer of type I, belonging to papillotubular adenocarcinoma. The depressed lesion on the greater curvature of the corpus belonged to differentiated adenocarcinoma, an early cancer of IIc type with sm degree of depth infiltration partially prodceing nodular invasion into the submucosa.

　As against a view of Muto et al. regarding the origin of type I early gastric cancer that early cancer having box-like muscle layer of the submucosa is other than canceration of polyp, the case here described is considered to be polypoid early cancer undoubtedly preceded by polyp, because, though the submucosal muscle layer in this case was also box-like, not only the mucous membrane constituting the main body of the polyp showed hyperplasia of epithels of the gastric pits and pseudo-pyloric glands, but also hyperplasia in the neck of the polyp was such that the mucosa involved by it was twice as high as that of the surrounding areas.

　This case, a multiple early gastric cancer of type I and Ⅱc, is of interest because of the evolutional process and depth invasion in each cancer.