平滑筋腫に合併したⅡb型早期胃癌の1例および韓国における胃癌について

Early Gastric Carcinoma, Typical IIb-Type combined with Leiomyoma: A case report

　韓国においても日本と同様に胃癌は非常に多く，全癌死亡の中で男子の癌では胃癌が第1位，女子では子宮頸癌についで第2位で，男女合わせてもやはり第1位となっている¹⁾．韓国の近代医学は第二次大戦後，欧米，特にアメリカの医学に負うところ少なからず，医学各分野にめざましい発達をとげてきた．しかしながら韓国人にこのように胃癌が多いにもかかわらず，胃癌の診断，特に早期胃癌の発見頻度は低く，切除胃癌中の早期癌の頻度は5％に過ぎない．胃癌診断技術の中で二重造影を含む胃X線検査法は早くから広く普及しているが，内視鏡検査は1968年頃からようやく始まり，徐々に普及しつつある．われわれは1973年9月から本格的に胃内視鏡検査を施行し，今日までに8例の早期胃癌を内視鏡的に診断しえた．今回はその8例中，特に興味ある典型Ⅱb型早期胃癌1例を報告し，あわせて韓国における胃癌の現状を紹介したい．

　We report a case of early gastric carcinoma, typical IIb-type, incidentally found during biopsy of minute submucosal tumor detected in gastroendoscopy and present some recent status of gastric carcinoma in Korea.

　A 69 year old man visited Cheil Hospital with a two years' history of progressive epigastric distress and indigestion. Upper G. I. X-ray series revealed nothing specific in both the stomach and duodenum. However, gastroendoscopy showed an elevated lesion, 1.5 cm in diameter, on the anterior wall of stomach body. The lesion was covered by essentially normal mucosa without any distinct demarcation and it appeared to be a submucosal tumor, showing so called bridging fold appearance. The biopsy specimen taken from the elavated lesion, however, suggested mucocellular adenocarcinoma. Subtotal gastrectomy was done under the diagnosis of elevated type early gastric carcinoma.

　Resected specimen showed a leiomyoma, measuring 13 mm in diameter on the submucosal layer of anterior wall of the stomach body, and its corresponding mucosal surface was more or less protruded into the gastric lumen, whereas the mucosa itself seemed not to be abnormal. The mucosa of anterior gastric wall distal to the lesion and the area of lesser curvature were somewhat discolored and more atrophic. However, there was no evidence at all of depression, irregularity or hemorrhage.

　Histologically, a spherical leiomyoma, about 10 mm in diameter, was found in the anterior wall of the stomach body. The gastric mucosa in wide extent measuring about 65×45 mm from the top of leiomyoma to distal anterior wall and lesser curvature was involved with mucinous cell carcinoma identical with the previous biopsy findings. On cut section of the specimen, there was not any difference in height between the area of cancer and that of normal mucosa. The cancer was limited within the mucosa but it was never exposed to the mucosal surface. The lymphnodes and other abdominal viscera were free from metastasis.