色素着色法で著明な着色をみたⅠ型およびⅡb＋Ⅱc型早期胃癌の重複症例

A Case Report of Double Early Gastric Cancers Clearly Diagnosed with Endoscopic Dyeing Method

　現在の早期胃癌の診断は一部の病変，たとえばⅡbとか微小胃癌（＜1cm）を除けば，ほぼ満足すべき成果を挙げているように思われる．しかしなかには通りいっぺんの検査ではしばしばその範囲までも含めた正確な診断のむずかしい症例もある．このような症例やⅡbないしは微小胃癌に対して，なんとかこれらを簡単に診断できるような方法はないものかと多くの努力が払われているが，まだその実状は悲観的である．

　内視鏡的色素着色法^1)～4)はこのような見地から少しでもこの壁を打破しようとする意図のもとに試みられている．本症例の病変は幸いにもこの着色法によりきわめて著明な着色を示し，この診断を一層容易なものとした．そこで本症例の診断経過，組織学的特徴を示すとともに，この色素着色法についても触れてみたい．

　This case had two early gastric cancers. One of them was minute I type of approximately 0.2×0.2×0.4 cm in dimensions on the anterior wall of corpus which was recognized as small polypoid lesion by x-ray and endoscopy, and confirmed as cancer by biopsy. Another one was Ⅱb+Ⅱc type on the greater curvature of antrum. This lesion was observed in the first x-ray examination and endoscopy as the deformity and erosive change. And then biopsy specimens also revealed the cancer but it was difficult to delineate the infiltrated margins of this lesion from the x-ray and endoscopic pictures.

　Therefore, an endoscopic dyeing method by Methylene blue for two lesions was performed. I type of the cancer on the corpus was markedly dyed only in the protruded part. In the lesion on the antrum, marked dyeing was also observed on the center of this lesion which had been found as the erosive change in the first endoscopy, and clearly delineated discolored part from the normal gastric mucosa around the dyed area was widely observed. This discolored area might be considered the invaded area by cancer as the accompanied Ⅱb.

　After these examinations, gastric resection was carried out. In the resected specimen, the dyed areas revealed the exposed cancerous tissues to the gastric lumen and although undyed discolored area was also the infiltrated part by cancer, malignant tissue of this part was not exposed and covered with non-malignant regenerative epithelium. This histological fingings might be a reason to decide the dyed area and undyed discolored area, and to make clearly the margin of cancer delineated in the endoscopic dyeing.

　Since the application of this endoscopic dyeing method is much valuable for the exact diagnosis of the early gastric cancer as described above, a possibility for the easy diagnosis of the early cancer must be greatly expected with this application.