Ⅱa＋Ⅱc型早期胃癌の1例

A Case Report of Early Gastric Cancer, Ⅱa＋Ⅱc Type

　近年の早期胃癌の発見はめざましいものがあるが，各施設における肉眼分類のばらつきが指摘され，肉眼分類の再検討が議論されている．

　われわれは集検にて発見された早期胃癌でⅡc内にⅡa集簇様隆起を認め，その隆起が非癌粘膜から成り立っている症例を経験したので報告する．

　A 69-year-old man having no complaints visited our department for check-up, because of abnormality pointed out previously at our gastric mass survey in 1976.

　The initial radiographic examination revealed small polyps on the posterior wall near the lesser curvature of the lower corpus. Endoscopical examination revealed a shallow depression around these polyps. Biopsy from the depression performed at the same time was positive for cancer. From these results, the diagnosis was Ⅱa＋Ⅱc type early gastric cancer.

　Macroscopically, several small low polyps were found in the shallow depression and their color or glistening was the same as the normal mucosa surrounding the depression. We were able to trace cancer around the shallow depression. The lesion measured 23 mm by 18 mm. Histological study clarified that these polyps themselves were negative for cancer.

　One of the polyps consisted of regenerative mucosa of ulcer scar and the others of hyperplasia of foveolar epithelium with edematous interstitial tissue.

　Cancer cells identified histologically with well differentiated tubular adenocarcinoma were found only in the shallow depression and they invaded submucosal layer around the polyps.