Retrospectiveにみても深達度診断が困難であったⅡa＋Ⅱc型早期胃癌の1症例

Early Gastric Cancer, Type Ⅱa+Ⅱc, Difficult to Diagnose the Depth of Invasion from the Retrospective Study, Report of a Case

　術前に深達度mのⅡa＋Ⅱc型早期癌と診断したが，切除胃の病理組織学的検索にて，深達度がsmであった症例を経験したので報告する．

　X-ray and endoscopic examination of upper G-Ⅰ tract were performed on a 65-year-old man without complaint.

　They revealed a protruded lesion with central depression and peripheral elevation on the anterior wall of the antrum. The border of the lesion was irregular and the surface was finely nodular. The central depression was shallow and accompanied by erosion.

　Biopsy specimens obtained from the lesion were histologically moderately differentiated adenocarcinoma.

　So, we diagnosed the lesion as Ⅱa+Ⅱc type early gastric cancer with depth of mucosal invasion.

　A partial gastrectomy was undertaken. Histological examination of the resected stomach showed that the lesion invaded the submucosa. Macroscopically, the lesion was 16×14 mm in diameter.

　This case was a polyp type in the classification of Ⅱa+Ⅱc type early gastric cancer by Sano. In this type if the greatest diameter was less than 20 mm, central depression was shallow and the surface of the lesion was finely nodular, the depth of cancerous invasion was limited to more m layer than to sm layer.

　In preoperative and retrospective study, it was very difficult for us to estimate this case as sm layer invasion clearly.