早期癌Ⅰと微小胃癌Ⅱaが併存した多発性隆起性病変の1例

Multiple Protruding Lesions of the Stomach in which Type I Early Cancer and Minute IIa Cancer were Coexistent, a Case Report

　比較的大きな隆起性病変の大部分は異型上皮巣で，これに分化型癌巣が混在し，これより遙かに小さい隆起性病変は微小胃癌Ⅱaで，その他に小隆起性病変3コが併存する多発性隆起性病変の1例を報告する．

　A case of multiple protruding lesions of the stomach is described. Most of a relatively large protrusion consisted of atypical epithelium, intermixed with a well differentiated cancer lesion. Another far smaller protrusion of relatively flat surface measuring 10 by 6 mm was entirely cancerous, It was a minute IIa cancer. In addition, three other small protrusions coexisted.

　The patient, a woman 56 years of age, was slightly anemic, but was well nourished, weighing 59 kg. Her mother died of liver cancer at 70. The patient visited us on account of heavy and unpleasant feeling in the right lower quadrant. There was no complaint referrable to the stomach. Roentgenography and endoscopy referrable to the stomach. Roentgenography and endoscopy revealed a large protruding lesion located squarely over the lesser curvature a little oral from the angle. The diagnosis then was type I early cancer. Gastric biopsy demonstrated only atypical epithelium in this growth, but reportedly cancer could not be ruled out. The antrum was narrowed as in the shape of a banana, and here were found four other protrusions as well.

　Gross findings of the resected stomach almost corresponded to those of radiography, but repeated histological examinations finally demonstrated cancer nests in 3 blocks on the posterior wall, again confirming the truth of common knowledge that cancer nests can often be found in the tissue of atypical epithelium when it is larger than 20 mm in diameter. Most of the rather flat protrusion on the lesser curvature of the pyloric antrum was malignant, Minor nests of atypical epithelium measuring 10 X 6 mm were also recognized there. The mucosa in other areas showed intestinal metaplasia in association with atrophic changes. The larger protrusion is believed to represent canceration of polyp as small cancer nests were mixed with those of atypical epithelium