X線的にⅡcの周辺粘膜下隆起が深達度診断に有用であった早期胃癌の1症例

A Fluorolucent Area Around a Ⅱc Depression Indicates Submucosal Cancer Invasion, Report of a Case

要旨　患者は42歳，女性．胃検診のX線検査で異常所見を指摘され，精査のために来院した．内視鏡検査で幽門前庭部前壁にⅡ_c病変を認め，生検診断で印環細胞癌と診断された．精査X線検査で幽門前庭部前壁に不整形の陰影斑の中に顆粒状陰影のみられるⅡC病変を認めた．そして，その陰影斑の周辺にはっきりしない粘膜下隆起様の透亮像を認めた．深達度診断は，この陥凹周囲の透亮像の所見を粘膜下層浸潤の所見と診断した．切除胃では幽門前庭部前壁に2.0×1.7cmの大きさのⅡ_c病変を認め，病理組織診断では粘膜下層に癌の浸潤を認めた．Ⅱcの陥凹周囲のX線上の透亮像は癌の深達度診断の指標の1つである．

　A 42-year-old woman was admitted to our clinic for detailed examination about the abnormal finding noticed in a mass survey x-ray examination. Ⅱc type of early gastric cancer in the anterior wall of the antrum was revealed in the endoscopy and biopsy.

　Next, double contrast x-ray film in the prone position showed the Ⅱc lesion ― irregular, faint barium fleck with granular shadow ― in the anterior wall of the antrum. The fluorolucent area, appearing like submucosal elevation was revealed around the Ⅱc depression and was diagnosed as the submucosal cancerous invasion. Resected specimen demonstrated the Ⅱc lesion measurring 2.0×1.7 cm and an elevated area around the Ⅱc depression. Pathological examination showed signet-ring type cancer cells in the mucosa of the Ⅱc depression and submucosal invasion spreading just under the mucosal cancer.

　A fluorolucent area around a Ⅱc depression is one of the indicators of submucosal cancerous invasion.