微小胃癌の1例

A Minute Carcinoma of the Stomach, a Case Report

　胃癌も1cm以下の微小胃癌が，発見されるようになり，診断面，治療面および病理学的に，新たな問題が，提起されてきたように思われる．

　われわれは胃レ線および側視型内視鏡で看過され，直視型内視鏡による近接拡大観察下の生検で，術前に診断できた微小胃癌を経験し，若干の考察を加えて報告する．症例は，50歳主婦，著患を知らず．実兄が胃十二指腸潰瘍で胃切術．とくに苦訴は無かったが，精検を希望して来診．

　A minute carcinoma, measuring 4×6 mm, located dirctly above the angle, was detected along with multiple protrusions showing intestinal metaplasia in the antrum. The carcinoma was confirmed as such by biopsy by means of close-up and enlarged observation afforded by a forward-viewing endoscope, GIFD. While macroscopically it was a healed erosion, histologic study revealed adenocarcinoma in the lamina propria beneath the healed erosions, which was covered with non-cancerous epithels. There was neither submucosal infiltration nor lymph node metastasis.

　Distant view of the lesion with a side-viewing type endoscope did not suffice to confirm even the existence of milignancy. Aiming biopsy also proved negative for cancer.

　In the diagnosis of minute cancer of the stomach target biopsy with close-up and enlarged observation device incorporated in an endoscope of forwardviewing type does seem far superior to that of sideviewing variety.