比較的早い時期の胃スキルスの1例

A Case Report of Scirrhous Cancer of the Stomach at Relatively Early Stage

症例

　患　者：25歳　女性

　主　訴：心窩部膨満感

　術前診断：胃体部前壁のスキルス

　手術：1975年9月7日

　術後診断：Borrmann4型（粘膜面陥川部の大きさ7mm×6mm，周辺隆起部の大きさ56mm×36mm）深達度ss，poorly. diff. adenocarc.，scirrhous．浸潤範囲の大きさ62mm×53mm．

　X線検査所見

　Fig. 1（立位正面充盈像）：胃体部大彎のふくらみは悪く，矢印間に辺縁の直線化がみられる．

　Case : A 25-year-old female.

　Chief complaint : Sensation of fullness in the epigastrium since 2 weeks.

　Preoperative diagnosis : Scirrhous cancer on the anterior wall in the upper body of stomach.

　Date of operation : September 5, 1975.

　Postoperative diagnosis : Advanced gastric cancer of Borrmann 4 type (The size of this cancer was 62×53 mm with an invasion of ss degree depth. The histology of this cancer was differentiated adenocarcinoma scirrhous).

　Macroscopic and histological findings were summerized as follows :

　1) The size of the depressed area was as small as 7×6 mm with a surrounding elevated area of 52×36 mm in size.

　2) The invasion of the cancer cells was limited in the depressed area in the mucosal layer and was spreading in the ss region over the elevated area as wide as 62×52 mm.

　In summary, two points could be emphasized the radiographic findings of this case. One was a pattern of lateral stripes which were made by the invasion of the poorly differentiated cancer cells with connective tissue fibers. The another point was a pattern of erosion with a irregular, oozing and worm-eating figure in the elevated area which might be confused with a submucosal tumor. This figures were photographed clearly only by compression radiograph and useful for the differential diagnosis of cancer from submucosal tumor.