早期胃癌に併存した胃の良・悪性境界領域病変の1例

A Borderline Lesion Complicated with Early Gastric Cancer

　われわれはⅡa＋Ⅱc型早期癌を併存したⅡc様の陥凹性病変を経験した．この陥凹性病変は組織学的に極めて興味のある所見を示したので，X線像ならびに組織像に若干の考察を加えて報告する．

　A 60 year-old woman started to feel pressure in the epigastrium after meals and an increase in anorexia since early June of 1978 and was admitted to our hospital on June 26 of the same year. According to examinations upon admission, no disorder other than light anemia was detected. By x-ray examination of the stomach, lesion Ⅱa+Ⅱc was discovered in the anterior wall of the antrum and a depressed lesion not in series with the former lesion was found in the central portion of the anterior wall. The gastric biopsy of the former was tubular adenocarcinoma and on July 6th, 1978, gastrectomy was performed. The latter was a small and narrow depressed lesion 9 mm×9 mm in size and clinically, differential diagnosis of Ⅱc, flat erosion, depressed type of borderline lesion could not be made. Pathological examination showed that the Ⅱa+Ⅱc lesion was a well differentiated tubular adenocarcinoma localized in the mucosa.

　The interesting thing about this case is the depressed lesion in the central portion of the anterior wall which is not in series with the Ⅱa+Ⅱc lesion. In the depressed area, the fundic gland had completely disappeared and replaced by an atypical gland showing intestinal metaplasia. The location of the occurence of atypism was in the upper part of the gland, that is, in the foveolar area, which showed marked atypism and less uniformity in its mode of atypism. Tendency for incomplete formation of the gland duct, advanced structural atypism such as deformity of the gland duct, advanced cellular atypism, decrease in the number of goblet cells and in its polarity in the epithelium of the gland structure (abnormality of differentiation and depression in the metaplasia epithelium). Ring-shaped atypical gland duct were seen.

　According to the above findings, the depressed lesion in the central portion of the anterior wall of the antrum is a type of atypical lesion different from that of atypical epithelium of the stomach, and a type of borderline lesion which can be said to be a severe dysplasia deviating into a poorly differentiated adenocarcinoma.