Ⅱc型早期胃癌の1例

A Case of Ⅱc Type Early Gastric Cancer

症例

患者：70歳　男性　ブリキ職入

家族歴，既往歴：特記すべきものなし．

現病歴：約2～3カ月前より，心窩部の不快感がありこの頃より初診時までに約3kgの体重減少を認めた．

　約3週前，某医にて胃レントゲン検査を受け，胃角附近に病変を指摘された．

昭和44年6月30日，本院を受診した．

現症：体格中等．栄養中等．貧血なし．リンパ腺腫脹なし．胸部理学的所見なし．腹部では心窩部に軽い圧痛を認めた．肝二横指触知したが，脾・腎は触知しなかった．抵抗なし．腫瘤も触知しなかった．

　Case: a 70-year-old tinman.

　Course: Since several months before the medical examination, he had queasy feeling in the epigastrium, losing 3 kg in weight in the interim. As an abnormality was found in his stomach by a certain doctor at x-ray examination, he was referred to the authors’ hospital.

　Present status: Epigastrium was slightly tender on palpation. The liver was palpated about 2 cm below the costal arch. It was of normal consistency and no tumor was palpated. No swelling of lymph nodes was recognized.

　X-ray examination of the stomach: In an area around the gastric angle was seen a wide, shallow depression with a slightly deeper excavation within it. The mucosal folds there showed swelling, tapering and abrupt cessation.

　Endoscopic findings: A wide, shallow depression was seen in the gastric angle. No ulcer lesion was recognized within it. The mucosal folds likewise showed swelling, tapering and abrupt cessation. The diagnosis was thus made of type early gastric cancer.

　Operation: subtotal gastrectomy. No lymph node metastasis was recognized 　Findings of the resected stomach: On the lesser curvature at the angle a little toward the posterior wall was seen a closed ulcer scar, measuring 1.5 cm in diameter. It was in the center of a shallow Ⅱc depression extending around it.

Histopathological picture: The ulcer scar was that UI-Ⅲ of ulcer. The surrounding depression was replaced in its cells by those of tubular adenocarcinoma. Their atypicality in structure was slight.