悪性所見に乏しく生検で初めて診断されたⅡb＋Ⅱc型早期胃癌の1例

Difficulty in Diagnosing Malignancy of Type Ⅱb＋Ⅱc (m) Early Gastric Cancer without Biopsy Specimen, Report of a Case

要旨　患者は63歳，女性．胃集団検診で胃角変形（小彎辺縁硬化不整）を指摘され，当センターを受診．初回内視鏡検査で胃体下部小彎の潰瘍瘢痕と診断されたが，その前壁寄り辺縁の生検でGroup Ⅳが検出された．しかしその後の検査では癌の確定診断が得られなかったため経過観察となった．2年後の内視鏡検査でも悪性所見に乏しかったが，瘢痕部からの生検で癌と確定診断されたため，胃亜全摘術を施行．病変は大きさ25×14mmのⅡb＋Ⅱc型早期癌，深達度m，tub2であった．臨床像が悪性所見に乏しく，生検で初めて確定診断が得られた症例を経験したので報告した．

　A 63-year-old woman was admitted to our center because she was diagnosed as having gastric ulcer scar. She was initially diagnosed as having multiple gastric ulcer scars but histological examination of the biopsy specimen showed Group Ⅳ. However, no matter how many examinations were made, cancer was not detected.

　Two years later an endoscopic examination still couldn't detect any indication of malignancy, but a biopsy specimen showed histological evidence of cancer. Therefore subtotal gastrectomy was performed.

　The pathological change was 25×14 mm of Ⅱb＋Ⅱc type early gastric cancer and tub2, m in depth.

　It may be difficult to make a diagnosis of cancer even after several examinations, as in this case, because cancer spreads irregularly so it is hard to determine it's size. Furthermore, the gastric ulcer scars surrounding the cancer also makes it hard to detect. Therefore, we should pay much more attention to a patient with a suspected ulcerated gastric cancer as well as informing such a patient about the difficulty in detecting the cancer, and the need to make follow-up examinations on the lesion more carefully.