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Stomach and Intestine(Tokyo) Volume 12, Issue 3 （March 1977）

胃と腸 12巻3号（1977年3月発行）

Japanese English

症例

Ⅱa集簇型を思わせた若年者胃癌の1例 A Case of Gastric Carcinoma in a Young Female Simulating Ⅱa-Aggregated Polypoid Type 磨伊正義 ¹ , 村俊成 ¹ , 吉田通章 ¹ , 上田博 ¹ , 秋本龍一 ¹ , 木南義男 ¹ M. Mai ¹ , T. Mura ¹ , M. Yoshida ¹ , H. Ueda ¹ , R. Akimoto ¹ , Y. Kinan ¹ ¹金沢大学がん研究所付属病院外科 ¹Dept. of Surgery, Cancer Research Institute Hospital, University of Kanazawa pp.359-364

発行日 1977年3月25日 Published Date 1977/3/25

DOI https://doi.org/10.11477/mf.1403112545

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Abstract 文献概要
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　若年者胃癌にみられる肉眼型は，そのほとんどが陥凹型を示し，隆起型胃癌はきわめて少ない．われわれは最近27歳，女性で，臨床上Ⅱa集簇型を思わせた若年者胃癌の1例を経験した．本例はきわめて奇異な肉眼像を呈し，臨床上悪性リンパ腫，潰瘍性びらん性胃炎との鑑別に難渋したので，その鑑別診断を中心に若干の検討を加え報告する．

　Gastric carcinoma in young adults usually shows depressed type in the gross appearance and polypoid type is extremely rare.

　Since the authors have seen a case of gastric carcinoma in a young female roentgenographically as well as endoscopically simulating Ⅱa-aggregated polypoid type, the case is reported.

　A 27-year-old female complained of dull epigastric pain off and on for the past several years. Gastric series revealed Ⅱa-like small elevations involving all areas of the pylorus which were defined from the surrounding mucosa. In endoscopic findings, bulging and meandering mucosal elevations associated with multiple superficial ulcerations in the cancer were observed. Indigocarmin-scattered picture emphasized fine unevenness and granules of the elevated mucosal surface and gave a striking contrast against the surrounding mucosa. From these findings, Ⅱa-aggregated carcinoma was suspected, but it appeared difficult to rule out completely the possibility of ulcero-erosive gastritis or malignant lymphoma. Gastric mucosal biopsy demonstrated poorly-differentiated adenocarcinoma, and gastrectomy was carried out. Histologic study of the resected stomach disclosed Ⅱc advanced cancer with superficial invasion of the muscularis proria. That is, the flat elevations like Ⅱa in the depressed area of Ⅱc and Ⅱa-like elevation of the marginal portion of the cancer were interpreted as a protrusion secondary to infiltration and proliferations of carcinoma cells in the middle and lower portion of the mucosa and further down into the submucosa.

　Since this case displayed a very peculiar looking gross appearance as mentioned above, clinical differentiation from malignant lymphoma or ulcero-erosive gastritis was very difficult. Discussions are made with special reference to its differential diagnosis.