胃の隆起性異型上皮からの癌化と考えられる1症例

Micro-adenocarcinoma of the Stomach Stemming from Atypical Epithelium, a Case Report

　胃の隆起性異型上皮巣は，隆起型早期胃癌と鑑別を要する病変として注目され，長与¹⁾²⁾，菅野，中村，高木ら^3)-5)，望月，福地ら⁶⁾を中心として切除胃および生検材料の病理組織学的検索，並びに臨床的研究が行われて最近そのおおよその概念が確立されてきた．しかし，異型上皮巣はdisease entityなのか否かに関してはいまだに病理学者の間に見解の相違があり，またその本態についてもneoplasiaとする見解とdysplasiaとする見解があり⁷⁾，必ずしも統一されているとはいい難い．さらに異型上皮からの癌化の可能性については，明確な結論をだすまでには至っていない．本例では，切除胃の病理組織学的検索により，広い異型上皮巣の表層に微小な癌巣が発見された．異型上皮からの癌化を思わせる興味ある症例と考え報告する．

　The patient, a 71-year-old man, had a complaint of sense of fullness in the abdomen. About two years before he had been diagnosed by his doctor to harbor protruding type of atypical epithelium of the stomach. In April 1978 we were asked to make thorough check-up for an indication of surgical exploration. Physical examination at admission showed only slight anemia in the palpebral conjunctiva. Laboratory examinations also showed slight anemia in the peripheral blood.

　X-ray and endoscopy of the stomach showed a clusther of low elevations of various size in a wide area extending from the lower corpus down to the antrum centering on the posterior wall in the angle area. The lesions called for strict discrimination between atypical epithelium and clustered Ⅱa type cancer. Because the surface of the elevations was relatively smooth with no erosion or reddening and no cancer cells were detected by biopsy, we arrived at a diagnosis of atypical epithelium of the stomach. However, since the lesion as a whole measured more than 2cm in diameter, we were unable to rule out the possibility of partial cancer nests. Gastrectomy was performed.

　Macroscopically a cluster of low elevations of varying size was recognized in an area measuring 55×30 mm centering on the posterior wall of the angle. The lesions were of soft consitency with relatively smooth surface. There was no erosion or reddening. Histologically the upper half of the protruded mucosa was covered with glands with superficial intestinal metaplasia showing various degrees of atypia. A very minute changes suggesting cancer was found in a part of it. These finding suggested that we were dealing with an incipient stage of canceration. Reference is also made to the literature.