Ⅱc型早期胃癌に類似した良性疾患の1例

A Case of Benign Gastric Lesion Resembing Ⅱc Type Early Gastric Cancer

はじめに

　早期胃癌Ⅱc型に類似した非癌性病変についてはいろいろの検討がなされているが，両者の鑑別は必ずしも容易ではない．筆者らは最近，比較的広汎な陥凹を呈したⅡc類似良性疾患の1例を経験したので，ここにその大要を報告する．

　A 58-year-old man having had an episode of epigastralgia and heartburn in Nov. 1967 underwent later x-ray examination of the stomach. A gastric ulcer was suspected then. Subjective symptoms soon disappeared under medical treatment. In July of the following year he visited the authors’ hospital for thorough check-up.

　At x-ray examination, convergence and cessation of the mucosal folds were noticed in an area surrounding the gastric angle. Endoscopy revealed a fairly wide area of depression encircled by the mucosal folds which ceased at the border of the depression. Its surface was almost smooth with no difference of mucosal tint from the surrounding area. No rigidity was seen in the discontinued rugae. Direct vision biopsy disclosed no malignancy. In the subepithelial space collagen fibers as well as round cell infiltration were noticed. Preoperative diagnosis: suspicion of a benign lesion with Ⅱc-like appearance.

　Operation was performed on Sept. 11. The resected stomach showed abrupt cessation of the mucosal folds around a relatively well circumscribed depressed area surrounding the gastric angle, measuring 60 by 30 mm. The surface of the depression was mostly smooth without any bleeding or white exudate over it. Tapering or swelling of the rugae was not to be seen.

　Histologically no malignant findings were demonstrated. In almost the whole area of the depression was seen a picture of regenerating mucosa, including a part covered with a single layer of columnar epithelial cells and collagen fibers appearing in the subepithelial space in the process of repair. No noticiable change was seen in the submucosa and muscle layers.

　The authors are of opinion that chronic atrophic gastritis and mucosal regeneration account for the Ⅱc-like depression seen in this case.