深達度mと術前診断したⅡa＋Ⅱc型sm胃癌の1例

Early Gastric Cancer, Type Ⅱa+Ⅱc, with Submucosal Involvement Preoperatively Diagnosed as Intramucosal Cancer, Report of a Case

症例

　患　者：59歳，男，会社員．

　現病歴：1980年1月より時々心窩部痛があった．9月，近医で胃X線・内視鏡検査を受け，異常を指摘され，10月に入院．

　A 59-year-old man with a nine months history of upper abdominal pain came to our hospital for full investigations. A barium meal study was reported as showing an irregular-shaped faint barium patch with a tiny central nodule surrounded by vague granular elevations on the posterior wall of the angle. Gastroscopy also well visualized an irregular-shaped shallow depression with red and fragile bottom and slight surrounding mucosal granularity. Positive identification of adenocarcinoma was obtained in biopsy specimens from the lesion and preoperatively, the patient was diagnosed as having an intramucosal early gastric cancer type Ⅱa+Ⅱc.

　Macroscopic survey of the resected specimen showed an early gastric cancer type Ⅱa+Ⅱc 20×20 mm in diameter. Histologically, infiltration of well differentiated adenocarcinoma was mostly limited to the mucosa, but it is of interest that cancerous infiltration down to the submucosal layer was noted at the point of the tiny nodule inside the depression which was well documented on the radiograph.