前壁Ⅱc型早期胃癌の1例

A Ⅱc Type Gastric Mucosal Carcinoma, a Case Report

はじめに

　この症例は，内視鏡とX線の術前診断が大きく相違していた症例である．内科入院約2カ月の問に，X線検査を3回，内視鏡検査を5回施行した．その結果，多発潰瘍が治癒傾向を示していること，および胃角に線状潰瘍があるということでは両検査法の結論は一致していた．しかし，現在，内視鏡検査のレポートは残っているが，フィルムそのものは，術前3週間のものしか残っていない．しかも，撮影条件が極めて悪いものしかなく，経過を明らかにできないのが残念である．

　A great discrepancy was found between x-ray and endoscopic diagnoses in a case of Ⅱc type mucosal carcinoma on the anterior wall of the stomach. At first, comparison of diagnosis by endoscopy with that by x-ray, clone with double contrast method in both the supine and prone positions, was such that we were sure that x-ray examination did not come up to our expectations, because endoscopy revealed an extensive Ⅱc lesion around a linear ulcer, while the only malignant finding in the x-ray was a depression of irregular shape on the lesser curvature side on the anterior wall of the corpus associated with convergence and abrupt cessation of the mucosal folds. Such a discongruity between these two methods of examination seemed to lessen in a great degree the diagnostic value of double contrast method, which is along with compression method the only available x-ray technique left for us for examining the gastric mucosal surface and superficial changes caused by gastric lesions.

　It is said that double contrast method in the prone position can show a lesion of Ⅱc type cancer only when its is more than 20 mm in diameter. It is also an impression that a lesion on the anterior wall is depicted much less clearly in the prone A-P projection. With due allowance for the ineflfilciency of double contrast method in delineating a very small cancer lesion on the anterior wall, a grave reflection was nevertheless called for. Histological diagnosis, however, was in favor of x-ray diagnosis. Reflection on this case, especially on cooperation of x-ray and endoscopy, led us finally to a correct diagnosis of type Ⅱa small mucosal carcinoma as reported in No.1 Vol.6 of this magazine.