X線・内視鏡でmないしsm1と診断したsm3胃癌の1例

Gastric Cancer with the Depth of Invasion of sm3, Which had been Evaluated as m to sm1 with X-ray and Endoscopic Study, Report of a Case

要旨　患者は62歳の男性．1999年8月心窩部痛出現．他院投薬でやや軽快するも症状持続したため9月当科受診した．胃内視鏡検査で胃体上部前壁に20mm大のⅡc病変を認め，生検で高分化型腺癌と診断された．深達度診断において，X線検査および内視鏡検査ではmないしsm1と診断した．超音波内視鏡では第1，2層に明瞭な低エコーを示す腫瘍エコーを認めた．sm層に2mm大の低エコー域が数個連なって認められたが，その形態からリンパ濾胞と判断し同じく深達度mないしsm1と診断した．噴門側胃切除術が施行されたが，最終病理診断は深達度sm3の管状腺癌であった．

　A 62-year-old male presented himself to our hospital with the complaint of upper abdominal pain. Endoscopic examination of the upper gastrointestinal tract was performed. The endoscopic findings revealed a Ⅱc lesion 20 mm in diameter at the anterior wall of the upper body. Pathological examination of the biopsy specimen showed well-differentiated adenocarcinoma. Double contrast barium study demonstrated a slightly depressed lesion with thin and irregular barium deposits. Endosonographic findings revealed a hypoechoic lesion in the first and second layers. There were a few hypoechoic lesions ranged in the third layer, but they were diagnosed as lymphoid follicles from their shape form. Finally the depth of invasion was evaluated as m to sml. Fundusectomy was performed. Histologically it was diagnosed as a tubular adenocarcinoma of the stomach with a depth of invasion of sm3.