興味あるⅡc＋Ⅲ型の早期胃癌症例

An Interesting Case of Ⅱc+Ⅲ Type Early Gastric Cancer

症例

　患者：K．N　63歳　男子

　主訴：体重減少

　家族歴：長男が胃癌にて胃切除を受く

　既往歴：小児時肺炎に罹患

　　　　　44年前内痔核の手術を受く

　　　　　24年前肝炎に罹患

　Case: a 63-year-old male. X-ray examination revealed, on the posterior wall nearer to the lesser curvature of the pyloric antrum, a small barium fleck surrounded by irregularity of a gastric area. Endoscopy revealed irregular reddening and a low protrusion of doughnut shape. These brought us to the diagnosis that it was Ⅱc+Ⅲ type early gastric cancer whose infiltration localizing within the mucosa. Gross observation of the resected stomach showed, on the posterior wall nearer to the lesser curvature of the pyloric antrum, a shallow depression measuring 1.4×2.7 cm, with ar deeper depression in the center and a low protrusion around it. Histopathologically it was adenocarcinoma tubulare mucocellulare, its infiltration extending down to the submucosal layer, with metastasis in the subpyloric lymph node and the node beside left gastric artery. Although in this case margin of Ⅱc was partly indistinct and change of the mucosal folds also was not dominant, irregular reddening and a low protrusion of doughnut shape revealed by endoscopic examination seemed to be useful for the diagnosis of the depth of cancerous invasion in the gastric wall.