約3年7カ月の経過にて隆起（Ⅰ＋Ⅱb）型早期胃癌より陥凹（Ⅱc＋Ⅲ）型早期胃癌へ進展したと思われる1例

A Case of Ⅰ＋Ⅱb Type Early Gastric Cancer Developed into Ⅱc＋Ⅲ Type

　胃癌の組織発生とその進展を検討する方法の1つとして，retrospective follow up studyが重要視され¹⁾，これに関しての多くの知見が得られている．従来の報告によれば，陥凹型早期胃癌はⅡbより発育する²⁾³⁾か，ないしは悪性サイクルを示すものがほとんどであり^4)～7)，隆起型胃癌より進展した症例の報告は見当らない．しかしわれわれは，約3年7カ月の経過観察にて胃角前壁のⅠ＋Ⅱb型早期胃癌がⅡc＋Ⅲ型早期胃癌となったと思われる興味ある1例を経験したので報告する．

症例

　患　者：72歳　男

　主　訴：心窩部痛，嘔気および少量の吐血

　家族歴：特記すべきものなし

　既往歴：18歳腸チフス，64歳肝硬変症

　現病歴：1972年7月14日より約2カ月間，肝硬変症の診断の下に本院内科へ入院，その際，胃透視にて角小彎の隆起陸病変を指摘されたが，そのまま放置した．退院後たいした自覚症状なく過ごすも，1976年1月21日心窩部痛，嘔気とともに少量の吐血をきたし，同年1月29日本院内科を受診，再び胃透視にて異常を指摘され，精査加療のため，同年3月1日入院した．

　An interesting case of 72 years male is described in whom Ⅰ＋Ⅱb type early gastric cancer developed into Ⅱc＋Ⅲ type early gastric cancer in the course of three years and seven months.

　X-ray taken on August 14, 1972, showed a welldefined oval protruding lesion on the lesser curvature of the angle. Endoscopy made on August 18 revealed a well-defined discolored area, dotted with reddish spots, on the anterior side of the protruding lesion. The biopsy specimen of the protrusion at that time was diagnosed ATP-like lesion. Compression radiograph on March 15, 1976, taken about three years and seven months later, did not demonstrate the protruding lesion on the lesser curvature of the angle. Double contrast radiograph showed a ragidity of the lesser curvature of the angle, and on its posterior side a depressed area with barium flecks and irregular granules were seen to which a few mucosal folds with its irregular tip seemed to converge from the anal side. Endoscapy and X-ray on February 14, 1976, did not show the protrusion, but instead an irregular-shaped ulcer on the same region and more prominent mucosal appearance of its anterior side, in which fine granules, erosions and bleeding spots were seen. The biopsy specimen taken at that time was diagnosed adenocarcinoma tubulare. The resected stomach on March 18, 1976, showed an irregular-shaped shallow depression with fine irregular surface, measuring 28 mm×17 mm, on the anterior wall of the gastric angle.

　It was accompanied with a few converging mucosal folds from the anterior side. An ulcer was seen in the center of the depression and a small Ⅱa-like protrusion was found on the anal side of it. Histological diagnosis was adenocarcinoma tubulare with depth of invasion sm.

　Retrospectively examined, the initial biopsy specimen had exactly the same microscopical findings as those of the lesion of the resected stomach. According to previous retrospective endoscopic follow-up studies, most of depressed type early gastric cancers are believed to develop from Ⅱb or show “malignant cycle”, and Ⅰ type early gastric cancer to develop into advanced cancer of Borrmann 1, 2 and 3 type. In this case, Ⅰ＋Ⅱb (Protruded) type early gastric cancer seemed to develop into IIc+III (depressed) type early gastric cancer in the course of about three years and seven months.

　As such, this case is considered very interesting.