重複微小早期胃癌の1例

A Case of Concurrently Occurred Double Minute Early IIc Type Gastric Cancers

症　例

　患　者：瀬○ロ　71歳　♂

　特記すべき主訴はなく，ドックのために入院した．

　家族歴：特記すべき事項なし.

　既往歴：5年前下血があり，胃潰瘍として治療を行っている．

　A 71 years old male visited our clinic for the purpose of a through physical checkup and, as a result, deformation was found by roentgenographic examination in the regions of angulus ventriculi and pyloric antrum. Double contrast examination revealed irregular “Fleck” in the posterior wall of the angulus ventriculi and a sulciform shadow within a granular shadow in the pyloric antrum region. Macroscopic observation showed similar finding, as shown by roentgenographic examination, of a shallow, irregular excavated lesion located in some measure to the posterior wall and of a sulciform ulcerative lesion with its mucosa being elevated located in a measure to the posterior wall of pyloric antrum. Both lesions were histologically adenocarcinoma tubulare.

　The minute gastric cancer found in the pyloric antrum was 2×7 mm in size and infiltrated along macroscopically excavated lesion, but did not whole sulciform lesion area. In other words, though the minute gastric cancer was detected by x-ray examination in the form of a sulciform shadow, its sphere did not coincide with the sulciform shadow. The sulciform shadow was wider and denser and its margin more sharp when compared with “Fleck” in the non-infiltrated lesion.

　Up to this time, in the field of roentgenographic examination much attention has been paid to reveal the resected specimen exactly. Except this, however, x-ray examination has another advantage of showing indentation of area, which may contribute to the diagnosis of the minute gastric cancer.