残胃大彎のⅡc型早期胃癌の1例

Type Ⅱc Early Gastric Carcinoma in the Giant Curvature of the Remnant Stomach, Report of a Case

要旨　患者は67歳の男性．23年前に胃前庭部の早期癌で胃切除術（BillrothⅡ法再建術，結腸前，Braun吻合あり）を受けている。無症状であるが，残胃粘膜のスクリーニング検査を内視鏡で行い病巣を見い出した．X線像では残胃大彎にひだ集中を伴い，小フレッケが存在する微細で不整な小区模様を呈する陥凹性病変であり，内視鏡的には，境界の滑らかな陥凹で，色調はやや褪色し，表面は光沢を有していた．残胃全摘術を施行，病理組織学的に径1.6×1.6cm，Ⅱc，深達度mの印環細胞癌であった．本例の粘膜表層に浸潤する印環細胞癌は，分化度が高く，粘液を胞体に有し，間質内浸潤を主体として増殖し，被覆上皮は保たれていた．内視鏡上光沢のある滑らかなⅡc局面は，この組織学的特徴が反映されているものと思われた．

　A case of Ⅱc type early gastric carcinoma of the remnant stomach in a 67-year-old male is reported. Gastrectomy had been performed 23-years previously when early gastric cancer of the antrum was diagnosed and the stomach was reconstructed antecollically with Braun's anastomosis, using Billroth Ⅱ anastomosis. Double contrast barium study demonstrated a flat depressive lesion with tiny barium deposits on the folds of the giant curvature of the remnant stomach. Endoscopical examination revealed a slightly depressed lesion on the folds, but superficially the lesion had only slight erosion and a smooth glossy appearance. As the biopsy specimen showed signet-ring cell carcinoma, total removal of the remnant stomach was performed. Macroscopically, a tiny depressive Ⅱc (1.6×1.6 cm) lesion was detected in the giant curvature of the remnant stomach and the surface of that lesion was very glossy. Histology revealed signet-ring cell carcinoma which had a well differentiated character with mucin products in the cytoplasm of the superficial mucosa of the stomach. It appeared that the tumor cells had also caused some destruction of the foveolar glands. We considered the smooth margin and glossy surface of the Ⅱc lesion to be an impotant histological feature of the differentiated character of the tumor.