表層拡大Ⅱa＋Ⅱc型胃癌の1例

Superficially Spreading IIa＋IIc Type Gastric Cancer, Report of a Case

要旨　患者は56歳，男性．検診の胃X線検査で胃角の異常を指摘され来院した．胃X線，内視鏡検査で胃角小彎を中心に広範囲に不整形の丈の低い隆起の拡がりを認め，その内部に瘢痕様所見を認めた．生検で高分化型腺癌を認め，胃全摘術を施行した．切除胃肉眼所見では胃体部から前庭部にかけて小彎を中心に7．8×7．0cm大の丈の低い隆起を認めた．病変の辺縁部では隆起が強く，中央付近では軽度陥凹していた．病理組織学的所見では，高分化型腺癌で，一部でわずかにsmに浸潤していた．われわれの施設では，隆起性表層拡大型胃癌は8例あり，本症例のごときⅡa＋Ⅱc型胃癌の6例はすべてsmであり，Ⅱa集簇型の2例はmであった．

　A 56-year-old man visited our hospital in October 1986 for further examination of a radiological abnormality of the gastric angle detected by a screening program. X-ray (Figs. 1-3) and endoscopic examinations (Figs. 4 and 5) revealed a wide flat elevation with a shallow central depression at the lesser curvature ranging from the gastric body to the antrum. Total gastrectomy was performed, because well differentiated adenocarcinoma was identified in the biopsy specimen. Resected specimen (Fig. 6 a) showed an irregularshaped elevated lesion of 7.8×7.0 cm in size, as well as a shallow central depression, spreading from the body to the antrum at the lesser curvature. Histologically (Figs. 6 b and 7) the invasion was limited to the submucosa in a very small area, which is different from the parts of the submucosal fibrosis.

　Superficial spreading occurs rarely in elevated type of gastric carcinoma in comparison with depressed type. We experienced 8 such cases (10.7％) at our laboratory. Six of these were IIa＋IIc type with the submucosal invasion, and the remaining two were IIa aggregated polypoid type carcinoma limited to the mucosa.