診断過程で示唆に富む微小胃癌の3例

Three Cases of Minute Mucosal Cancer of the Stomach Diagnosed by Magnifying Endoscopy with NBI without Biopsy, Report of a Case

要旨　〔症例1〕は，60歳代の男性．検診にて，胃体上部に発赤調陥凹性病変を散在性に認めた．NBI拡大観察にてWZの消失した不整な微細血管とDLを伴う3mm大の病変を1つ認めた．〔症例2〕は，70歳代の男性．胃癌EMR後にEGDを受け，胃体中部後壁に2mm大の発赤調陥凹を指摘された．NBI拡大観察ではDLと不整微細血管を有し，WZの消失した陥凹であった．〔症例3〕は，胃癌精査目的で紹介された50歳代の男性．近位前庭部大彎に多発する発赤を多数認めた．NBI拡大観察にて，後壁側の発赤調陥凹性病変内にWZの不整ないし消失，不整な微細血管およびDLを認めた．いずれの病変も分化型粘膜癌と診断し，生検を省略しESDにて切除した．組織学的にも治癒切除であった．

　Case 1 is 60's male with gastric cancer checked by healthy check. Magnifying endoscopy with NBI（ME-NBI）showed a small depressed lesion with demarcation line, 3mm in size, which had irregular vessels. White zone appearance was unclear. Case 2 is 70's male introduced in order to surveillance after EMR for gastric cancer. Gastroscopy showed a small reddish lesion, 2mm in size, in the posterior wall of the gastric body. ME-NBI showed an irregular microvessels and disappearance of white zone component with demarcation line. Case 3 is 50's male referred to our hospital for further workup of gastric cancer. Gastroscopy showed many number of redness in the greater curvature of proximal antrum. ME-NBI showed an irregular microvessels, irregularity and disappearance of white zone component with demarcation line. We diagnosed all cases as minute mucosal cancer consist of differentiated adenocarcinoma by ME-NBI findings. We treated three cases by ESD without previous biopsy and could curative resection histologically.