粘膜下腫瘍の形態を呈した進行胃癌の1例

Advanced Gastric Cancer Showing the Features of Submucosal Tumor, Report of a Case

要旨　胃穹窿部に粘膜下腫瘍の形態を呈した胃癌を経験したので報告する．患者は39歳，男性．主訴は心窩部不快感．胃X線検査と内視鏡検査で，胃穹窿部大彎に多発性の小さな潰瘍性病変とbridging foldを伴った粘膜下腫瘍様の隆起性病変を認めた．生検組織診断でGroupⅤ，低分化腺癌と診断された．手術切除標本では穹窿部大彎に大きさ42×40mmで多発する陥凹性変化を伴った隆起を認めた．隆起性病変の主な部位では粘膜下層で充実性の増殖を示し，正常粘膜を下から持ち上げている．癌細胞は低分化腺癌の形をとり，粘膜下層から固有筋層に充実性に浸潤し，一部で深達度ssβであり，ly₂，V₁でリンパ節転移は陰性（0/18）であった．

　A case of advanced gastric cancer showing the feature of submucosal tumor on the gastric fornix is reported. The patient was a 39-year-old male with gastric discomfort as his chief complaint. Radiographic and endoscopic examination of the stomach revealed a lesion suggestive of submucosal tumor with multiple and small ulcerations and bridging fold on the greater curvature of the gastric fornix. Histological biopsy diagnosed Group Ⅴ, poorly differentiated adenocarcinoma. The resected specimen showed an elevated lesion, measuring 42×40 mm, with multiple depressions. Histologically; the chief part of the elevation was tumor tissue in the submucosa showing nodular proliferation, and forcing up the normal mucosa from underneath. Cancer cells of poorly differentiated adenocarcinoma type were seen in the layer of the submucosa strongly invading the muscularis propria. The diagnosis was “poorly differentiated adenocarcinoma” with depth of invasion reaching the subserosa, ly₂, v₁. Metastasis to lymph node was positive (0/18).