特異な形態を呈した早期胃癌の1例

The Interesting Case of Multiple Gastric Cancer, Report of a Case

　胃前庭部前壁にⅡb様の早期癌と，それに接して多発密集するpolypoidの早期癌の症例を経験したので報告する．

　X-ray and endoscopic examinations of upper G-I tract were performed on a 31-year-old woman with a complaint of epigastralgia. These examinations revealed a flat lesion on the antral anterior wall and multiple polypoid lesion, which was localized on the posterior wall of antrum. The lesion on the anterior wall was characterized by the irregular and nodular mucosa without remarkable elevation or depression, and was easily diagnosed as cancer. As for the lesion on the posterior wall, x-ray and endoscopic pictures showed that multiple elevations of various sizes and forms existed with little spaces among them. Each elevation had reddish and smooth surface without erosion or ulceration. From these findings, this lesion was diagnosed as benign localized polyposis. But, the cancer was recognized in two out of three biopsy pieces taken from this polypoid lesion. Preoperative diagnosis of multiple polypoid lesion is multiple early gastric cancer of type Ⅱa, localized polyposis with cancers in parts or widely spread cancer which included polyposis.

　Macroscopically, in the antrum of the resected stomach, a slightly elevated flat lesion on the anterior wall and multiple elevations of various sizes in the posterior wall were recognized. Two lesions were across each other on the greater curvature.

　Histologically the flat lesion on the anterior wall was early cancer of poorly differentiated adenocarcinoma with m layer invasion. The polypoid lesion was well differentiated adenocarcinoma composed of epithelia of gastric foveolar type. On the greater curvature, cancer cells which were shown in the flat lesion of the anterior wall were present in the upper mucosal layer of polypoid lesion composed of hyperplasia of non-neoplastic, immature intestinal epithelium.