Ⅱb＋Ⅱc型早期胃癌の1例

A Case of Ⅱb+Ⅱc Type Early Gastric Cancer

はじめに

　胃癌診断法が著しく進歩したとはいえ，Ⅱb型早期胃癌の術前診断例は甚だ少ない．その大部分は癌や潰瘍などの他の合併病変によって手術し，偶然発見されたもので，一般には約2cm以下の比較的小さなものが多く，切除胃の肉眼所見でも判定不能なものが殆んどである．本症例はⅡb＋Ⅱc型早期胃癌のⅡc病変が最初Ⅱa様病変として認識され，その後の精検でⅡc病変と診断し切除を行ない，Ⅱb＋Ⅱc型早期胃癌と確認されたものである．

　Despite the remarkable progress made in the diagnostic methods of gastric cancer, preoperatively diagnosed cases of Ⅱb type early cancer are still few. Most of them are found quite accidentally in the course of operation for other types of gastric cancer or for ulcer and so on. Generally they are under 2 cm in diameter, so that they are very diflicult to identify even in the gross specimens of the resected stomach.

　The case here described is also a Ⅱb+Ⅱc type early gastric cancer coincidentally found in the neighborhood of a Ⅱc lesion on the lesser curvature of the pylorus for which gastric resection was originally attempted. Retrospectively, the Ⅱc lesion in the initial x-ray shows a slightly elevated lesion more like a Ⅱa, and the later confirmed Ⅱb is observed as an also elevated change together with gross areae gastricae and irregular meshy shadows.

　In the removed stomach, the mucosa of the Ⅱb showed pallor and loss of luster with its surface rough. The areae gastricae were more gross than normal and were of varying sizes.

　Although these findings were well reflected in the radiographs, much still remains to be solved before these minute x-ray findings can be utilized as nite definitesign of malignancy in this area. Nevertheless, the above-mentioned findings seem to furnish an important, though as yet slight, clue to its correct diagnosis, so that they should not be ignored.