12×7.5cmの広範に進展した陥凹型胃癌の1例

Depressed Type of Cancer Widely Spreading 12×7.5 cm in the Stomach, Report of a Case

要旨　患者は63歳，女性．1か月ほど前から食思不良を訴え，前医での胃内視鏡検査で異常を指摘され，当科に人院となった．X線所見におけるアレア像の変化，空気量を少なめにした仰臥位二重造影第2斜位像での噴門側の境界線の描出および内視鏡所見での粗ぞうな褪色調粘膜の範囲によって，体中部から前庭部にかけて胃角を中心とした広範に拡がる表層拡大型Ⅱc型胃癌と診断し，胃全摘術が行われた．切除胃肉眼所見では胃角部を中心に胃体中部から幽門前庭部にかけて浅いびらんを伴う境界の不明瞭な浅い不整な陥凹病変を12×7.5cmの範囲に認めた．病理組織診断は低分化型腺癌であった．大部分は粘膜内癌であったが，胃体部前壁にかけて粘膜下層内への浸潤がみられ，その部分でリンパ管浸潤と，ごく一部で固有筋層への浸潤を伴っていた．

　An 63-year-old woman was admitted to our hospital with the complaint of anorexia. Roentgenographic examination revealed shallow mucosal abnormality from the middle body to the antrum. Also, a slightly elevated portion in the abnormal mucosa was observed on the lesser curvature of the anglus and the antrum. Endoscopic examination showed discolored mucosa in the same area. Total gastrectomy was carried out, because the lesion was diagnosed as a gastric carcinoma of the superficial spreading type. The macroscopic view of the operated stomach, showed the lesion widely spread over an area of 12×7.5 cm from the middle gastric body to the antrum. Histologically the lesion was diagnosed as poorly differentiated adenocarcinoma. Throughout most of the lesion the carcinoma was spread in the mucosal and submucosal layers, but in a small part of it cancerous tissue was observed in the muscular layer.