診断上興味あるⅡa＋Ⅱc型早期胃癌の1例

A IIa＋IIc Type Early Gastric Cancer Interesting in the Diagnostic Process

　症例は66歳の女性で，病変は幽門部にあったにもかかわらず一部が十二指腸球部へ逸脱していたために診断に問題点があり，切除標本所見を併せ考えてもいささか興味があると考えられたので報告する．

　Case: A 66-year-old female.

　Preoperative x-ray examination revealed a protruded lesion locating at the antrum of the stomach near the pyloric ring prolapsed partly into the duodenal bulb.

　This protruded lesion had the sharp margin and depressed surface, but the protrusion and its surrounding gastric wall seemed to be soft.

　These findings suggested us a diagnosis of a IIa＋IIc type early gastric carcinoma.

　Endscopic pictures also revealed a soft protrusion with partly eroded surface diagnosed as a IIa＋IIc type early gastric carcinoma.

　But, the gross findings of the resected specimen of the stomach were different from our preoperative image.

　It showed an irregularly-outlined low protrusion with slightly depressed surface originating from the lesser curvature just above the pyloric ring, and the depressed area did not have any ulcerative changes on the surface.

　Histologically, this lesion was diagnosed as a well differentiated tubular adenocarcinoma spreading mainly within the mucosa, and invading the submucosal layer in a limited area.

　In this case, it was very difficult to describe the accurate shape of the lesion in the diagnostic process because it was located at the lesser curvature just above the pyloric ring.

　Especially in X-ray examination, the finding of a tumor prolapsing partly into the duodenal bulb led us to diagnose it as a benign one, a polyp or an intramural tumor.

　On the other hand, an important evidence for our diagnosis of an early stage of the carcinoma depended on the softness of the protruded lesion and its surrounding gastric wall.