Ⅱc型早期胃癌の1例

A Case of Ⅱc Type Early Gastric Cancer

はじめに

　早期胃癌，特にⅡc型早期胃癌の呈する所見についてはほとんど出っくされた感があり，その診断も病変がかなりの拡がりを有しているかぎり，さほど困難ではなくなっている．しかし，その陥山内部ならびに周辺粘膜をあますことなく，しかも素直に描写することにっいては，未だ困難なことにしばしば遭遇する．本症例は胃X線的に陥凹像およびその辺縁，さらにその周辺粘膜の変化が比較的素直に把握されたⅡc型早期胃癌の症例である．

　The characteristic findings of early gastric cancer, especially those of Ⅱc type have been described so far almost in its whole aspect, so that its diagnosis is relatively easy when the lesion has some extent. Nevertheless, some cases are difficult to reveal in their entire aspects of the lesion as they are together with its surrounding mucosa. In this respect, the case here presented is clearly demonstrated in the x-ray.

　The patient: a male, 50 years of age

　Chief complaint: epigastralgia

　Macroscopic and histopathological findings of the resected stomach: A depressed lesion as of Ⅱc, measuring 17 by 10 mm, is seen on the posterior wall of the antrum. Its margin shows intense irregularity surrounded with mucosal folds abruptly ceased and slight elevations. Histopathologically, this lesion was confirmed as aclenocarcinoma tubulare infiltrating into the submucosal layer.

　Radiological findings: In the double contrast radiograph there is on the posterior wall of the antrum a faint barium fleck with irregular margin surrounded with nodular elevations. While in the double contrast picture in the right anterior oblique position only the elevation of the mucosal folds near the lesser curvature is well demonstrated, changes in the depression and the adjoining mucosa are more clearly visualized as they are in the left anterior oblique position because they have been more distended.

　Even in the diagnosis of a lesion localized in segment easy to visualize as in this case, due regard must be paid to the movement of air within the stomach and its axial alteration incident on the frequent changes of the patient's position, so that additional examination methods as in a prone position are of importance in getting more accurate information.