多発性粘膜下囊腫を伴ったⅡc型早期胃癌の1症例

Ⅱc Type Early Cancer of the Stomach Associated with Multiple Submucosal Cysts, a Case Report

　従来，胃良性腫瘍のうち胃囊腫は比較的稀な疾患とされていたが，近年胃疾患の診断が容易となるとともに報告が散見されるようになり，びまん性の多発性囊腫，なかでも胃粘膜下層に多発性囊腫をもちながらその表層粘膜に癌を伴った興味ある症例が報告されるようになった．

　われわれは胃集団検診によって発見された，粘膜表面にⅡc型早期胃癌を伴なった多発性胃壁内囊腫と胃ポリープが併存していた興味ある症例を経験したので報告するとともに，いささか考察を加えてみたい．

　A 65-year-old man with no symptoms to complain of was referred to our department because at a gastric mass screenings he was found to harbor multiple lesions in the stomach such as a submucosal tumor in the lower body, a Ⅱc type early cancer and a polyp in the antrum. Roentgenography revealed a gently raised mucosal elevation extending over to both sides of the walls in the lesser curvature side from the midbody to the angle. On compression it would go away. We have also noticed an irregular barium fleck around the lesser cuvature of the antrum, where a rounded polyp-like shadow was also noticed. Endoscopy showed a gently sloping mucosal elevation of low stature, parted in three portions, over both walls of the lesser curvature side in the lower body. The surface of the protrusion was dotted with white coats and erosions. A well-defined Ⅱc-like depression and a polyp were also recognized over an area from the lesser curvature of the antrum to the posterior wall. Grossly the resected stomach showed three mucosal elevations, all measuring about 20 by 20 mm, one each on the anterior and posterior wall of the lower corpus and another on the posterior wall of the angle. In their centers were seen eroded spots. In addition, a depressed lesion, measuring 50×30 mm, along with a small polyp was noticed, located from the lesser curvature of the pyloric antrum way over to the posterior wall.

　Histologically, multicentric cancer nests, all localized within the mucosal layer, were demonstrated, extending from the lower corpus down to both walls of the pyloric antrum. Carcinoma simplex mucocellulare was seen side by side with adenocarcinoma tubulare mucocellulare. In the submucosal layer beneath the elevation in the lower body were seen many clusters of tubular glands consisting mostly of either cubic or cylindrical glandular epithels, showing in some parts cystic dilatation.

　We have assumed that our findings were more consistent with possible aberration of mucosal epithelia of the stomach than with that of pancreatic tissue. Some comments are added.