Ⅱa＋Ⅱc早期癌に良性潰瘍と良性ポリープを合併した多発病変の1例

A Case of IIa＋IIc Type of Gastric Cancer Combined with Scars of the Benign Linear Ulcers and a Benign Polyp

　患者：46歳　女

　主訴：空腹時上腹部痛

　家族歴，既往歴：ともに特記すべきことなし．

　現病歴：約2年前より主として空腹時に上腹部痛があり，最近になって痛みの回数が増してきたため本院を受診した．胃レ線および内視鏡検査を施行したところ，胃体上部に潰瘍が認められたので外来で加療を行ないながら経過観察しているうち，さらに第2回目の精密検査で胃体下部および幽門部にも後で述べるような病変が新らしく見つかり，入院の運びとなった．食欲は良好で体重減少もなく，便通は1日1行，規則的である．

　We describe a case of the multiple lesions of a woman 46 years of age with a IIa＋IIc early cancer on the anterior wall of the antrum, scars of the benign linear ulcers on the anterior and posterior walls of the upper portion of the corpus and a benign polyp on the posterior wall of the lower portion of the corpus.

　X-ray and endoscopy revealed IIa＋IIc early cancer on the antrum as the low protruding lesion with central shallow erosive concavity, and grossly granular irregularity was eminent on the surface of the protrusion except concavity. Histological examination revealed well differentiated adenocarcinoma tubulare. Most of this cancer located within the submucosa, and the mucosal surface of IIa lesion revealed no cancer. Only the central depression of the protrusion, or IIc, showed the exposed cancer on the mucosal surface, partly covered with normal epithelium even in the IIc lesion. Many of the IIa＋IIc early cancer show the tendency of peneting invasion to the gastric wall. In cases as this with narrowly exposed cancer, x-ray and endoscopy sometimes make it difficult to recognize accurately the range and the degree of the depth of the cancerous invasion. Then in biopsy the lesion must be closely observed to decide the location to take specimens.

　The lesion on the anterior wall of upper portion of the corpus was scar of linear ulcer of Ul-III, the lesion of its posterior wall was that of Ul-II, and the small protrusion on the posterior wall of lower portion of the corpus was regenerative hyperplastic polyp.