噴門部のⅡc＋Ⅰ＋（Ⅲ）型準早期胃癌の1例

A Case of Advanced Gastric Carcinoma in The Ⅱc+Ⅰ+ (Ⅲ) Type Near the Cardia

　本症例は，昭和44年12月の早期胃癌研究会において御検討をいただいた，深達度は深いが早期胃癌様肉眼所見を呈した症例である．比較的まれな型を示し，また部分的（隆起部分）には，急速な発育をしたと考えられる点が注目される．

This is a case of advanced gastric carinoma near the cardia seen in 38-year-old female with a chief complaint of nausea. Previous x-ray examinations of the stomach done in March and July in 1967 were misinterpreted as showing nothing abnormal. At the end of May and in the first part of Jnne in 1969, a lesion in the shape of Ⅱc+(Ⅲ) was recognized by x-ray and endoscopic examinations just underneath the cardia extending to the lesser curvature of the upper body. Repeated examinations at the end of June prior to surgery revealed emergence of an additional polypoid lesion underneath the cardia and cancer was comfirmed by endoscopic biopsy. Preoperative diagnosis, there fore, was cancer in the type of Ⅱc+Ⅰ+(Ⅲ), but the depth of infiltration was assumed to reach beyond the muscularis propria because of the extent of rigidity as seen in the x-ray films. On resection, the polypoid lesion below the cardia measured 2.2cm in diameter amd 1.0 cm in height.

Distal to it, extended the Ⅱc area along the lesser curvature, measuring 5×4.5cm in dimensions as a whole. In addition, puckering of the folds was noted, converging towards an area within the Ⅱc. Histologically, it was adenocarcinoma mainly confined to the mucosa and submucosa, with slight infiltration into the muscularis propria in areas and a nest of cells in a subserosal lymphatic channel. A special mention should be made that the polypoid lesion consisted of a mass of lymphoid tissue infiltrated by cancer. The rapid development of the mass, apparently within 25 days prior to surgery, may be explained by the additive growth of lymphoid and cancerous tissues. Previous failures in clearly demonstrating the lesion would indicate the difficulty in the diagnosis of lesions in the upper part of the stomach. The importance of combined use of x-ray and endoscopic examinations even at the screening step cannot be overemphasized.