範囲診断が困難であった低異型度分化型早期胃癌（手つなぎ・横這型癌）の1例

A Well Differentiated Adenocarcinoma with Low Grade Atypia, Report of a Case

要旨　患者は50歳代，女性．スクリーニングの上部消化管内視鏡検査にて体下部後壁に病変を指摘され，当院に紹介となった．上部消化管内視鏡検査上，前医生検によると思われるびらん周囲にわずかな陥凹を認めたが，生検にてその外側にも高分化腺癌を認めた．3回の内視鏡検査を行い，生検で非腫瘍であった部分を確認のうえ内視鏡切除を行ったが，小彎から肛門側にかけて切除断端に異型細胞を認めた．非治癒切除と判断して幽門輪温存幽門側胃切除術を行い，内視鏡切除後潰瘍から小彎，前壁にかけて手つなぎ腺管を形成する低異型度高分化型腺癌の拡がりを認めた．

　The patient in her late 50's was referred to our hospital because endoscopy showed a tumor located on the posterior wall of the lower gastric body. Upper gastrointestinal series and endoscopy showed an erosion with surrounding unclear depression on the posterior wall of the lower gastric body. Because the lesion's margin was unclear, an endoscopic examination was performed three times to determine the tumor margin. Then the endoscopic resection was performed. The resected specimen revealed that the lateral margins of the lesser curvature and anal side were affected with cancer cells. We considered additional resection was necessary, so pylorus preserving distal gastrectomy was performed. In the resected specimen, the cancer had spread widely in the lesser curvature to the anterior wall of the lower gastric body.