1年6ヵ月間経過を追ったⅡa＋Ⅱc型早期胃癌の1例

A Case of Ⅱa+Ⅱc Type Early Gastsic Cancer Followed Up for One and a Half Year

　経過を追った早期癌の報告は，近年数多く報告されている．しかしその多くは発育のきわめて緩徐な陥凹性早期癌についてであり，Ⅱa＋Ⅱc型早期癌，とくに粘膜集中をともなわない小Borrmann Ⅱ型に類似したⅡa＋Ⅱc型早期癌の経過追求例の報告はきわめてまれである¹⁾²⁾．

　筆者らは1年6カ月の問に比較的急速に発育したⅡa＋Ⅱc型早期癌の1例を経験したので報告する．

　Case: a 65 years old man. When in Nov. 1966 he underwent x-ray and endoscopic examinations for routine check-up, he was erroneously diagnosed as having atrophic gastritis. In May 1968 he revisited the authors because of hunger pain. Both x-ray and endoscopic examinations of the stomach disclosed this time a finding simulating a small Borrmann Ⅱ type gastric cancer on the anterior wall at the angle. It was strongly suspected as a Ⅱa+Ⅱc type early cancer, the more so as cytocliagnosis by brushing under direct vision was positive for cancer. At operation, a Ⅱa+Ⅱc type submucosal carcinoma (adenocarcinoma), measuring 1 cm in diameter, was recognized on the same site. There was no lymph node metastasis. As of March 1971 he is enjoying good health.

　Retrospective investigaon of gastrocamera pictures taken in Nov. 1966 shows that the site where cancer later developed was well photographed, and it is seen as engorged fleck looking like a shallow erosion of a little irregularly round shape, with a slight granular elevation of the mucosal surrounding it. As compared with the pictures taken just before the surgical operation, those at the previous examination show that the elevation is far lower and the depression much more ill-defined. However, on closer scrutiny, this lesion could be regarded as an early cancer lesion showing a visible tendency to Ⅱa+Ⅱc type. Spread of cancer on the mucosal surface level has shown little progress in the interim. Presumably it is because this lesion has evolved from a Ⅱb to this type, and its development has taken a vertical direction, protrusion and depression alike taking more distinct shape in such a way as to develop into a fullblown Ⅱa+Ⅱc type early cancer simulating Borrmann Ⅱ type advanced carcinoma.

　As weighed against the authors' seven personal cases depressed type early gastric cancer (Ⅱc, Ⅱc+Ⅲ and Ⅲ) followed up for more than eleven months, cancer development in the present case is considered to be fairly rapid.