噴門部Ⅱc型早期胃癌の1例

Early Gastric Cancer Type Ⅱc of the Fornix, Report of a Case

要旨　患者は53歳，男性で，人間ドック（間接集検）を受診し，胃角上部の異常を指摘された．内視鏡検査により胃角上部と，更に噴門部にも異常を指摘され入院となった．胃X線像では食道胃接合部にメガネ状の不整な淡いバリウム斑がみられ，そのバリウム斑の周囲は軽く高まっていた．内視鏡像では噴門部小彎に発赤した不整形の陥凹性病変を認め，その口側粘膜は食道粘膜に接していた．Ⅱc型早期胃癌と診断し，噴門側切除術を行った．噴門部小彎に大きさ7×13mmの中分化型管状腺癌が認められ，深達度はsmであった．また，胃角部小彎には縦長のUl-Ⅳの潰瘍搬痕を認めた．比較的発見が困難とされる噴門部の陥凹性早期胃癌を報告した．

　A 53-year-old man was found to have an abnormality at the mass survey of the stomach. Detailed examination was performed by endoscopy revealing two lesions one in the lesser curvature of the fornix and another at the gastric angle. X-ray examination revealed small barium fleck surrounded by slightly elevated area. Endoscopic examination showed a reddish and irregular shaped depressed lesion continuous to the normal esophageal mucosa. Biopsy specimen obtained from this lesion was positive for carcinoma. Proximal gastrectomy was performed. In the resected stomach existed the cancerous lesion measuring 13×7 mm in size. Pathologically, the submucosal layer was invaded by moderately differentiated tubular adenocarcinoma. Another lesion at the gastric angle was gastric ulcer scar with penetration to the proper muscular layer.