異型上皮巣として5年間経過を観察したⅡc型早期胃癌の1例

Ⅱc-type Early Gastric Cancer, Followed as an Atypical Epithelial Lesion for Five Years, Report of a Case

　初診時のX線検査で胃体部小彎の潰瘍瘢痕としてチェックし，胃生検で異型上皮の診断であったため，内視鏡検査を主として経過観察を続け，4年8カ月後（6回目）の生検でグループⅣの診断が得られた．初診から手術までの5年2カ月間に，X線検査を4回，内視鏡検査を16回，生検を11回施行し，手術した結果はⅡc病巣内に島状の異型上皮巣が存在した粘膜内癌であった症例を経験したので報告する．

　The patient was a 75 year-old woman. Five years and two months before operation, she visited our hospital with complaints of a heavy feeling in the epigastric region, nausea and anorexia. On the initial routine x-ray examination, an ulcer scar was found on the lesser curvature of the body, and then we performed endoscopy with biopsy, detecting a small protuberant atypical epithelial lesion on the posterior side of the lesser curvature.

　After about 5 years of follow up by endoscopy, biopsy and x-ray examination, however, another lesion of cancer was finally confirmed histologically just in the neighborhood of the protuberant lesion. On the resected stomach, Ⅱc type early cancer of 6.0×4. 5 cm was found located on the lesser curvature of the body. Histological study revealed well differential adenocarcinoma, limited just in the mucosal layer. Inside this Ⅱc area, an island-like lesion of 0.8 cm diameter was observed, which histologically consisted of atypical epithelium.

　Upper G-Ⅰ series, endoscopy and biopsy were performed 4, 16 and 11 times respectively in a follow up period of 5 years and 2 months. On the 11th endoscopic examination performed 4 years and 8 months after the first examination, the Ⅱc-like lesion was finally detected. Since then, however, only a diagnosis of group Ⅲ was obtained continuously on each succeeding 4 biopsy trials. And a diagnosis of group Ⅳ was established finally on the 6 th biopsy.

　When x-ray findings obtained 3 years ago (3 rd examination) were reviewed retrospectively, the lesion had been already faithfully visualized, which was strongly suggestive of Ⅱc.

　A diagnostic process of Ⅱc type early gastric cancer was reported, which was detected accidentally during a follow up of a protuberant atypical epithelium.

　During the course of long term, the cancerous lesion of Ⅱc might have developed gradually and spread superficially to such extent as to be observed endoscopically and diagnosed bioptically. The entire clinical course was 5 years and 2 months from an initial examination to a final operation.