限局性のリンパ細網組織の増生のためBorrmann 2型と術前診断したsm胃癌の1例

Early Gastric Cancer with Submucosal Involvement Simulating Borrmann Type 2 Advanced Cancer, Report of a Case

症例

　患　者：46歳，男，自営業．

　現病歴：1973年9月，胃潰瘍を指摘された．1975年3月，心窩部痛があるため，胃X線検査を受け，胃癌を疑われ，4月入院す．

　A 46-year-old man with along history of peptic ulcer disease was referred to our clinic for investigation and treatment of possible gastric cancer. Both a barium meal study and gastroscopy visualized a big crater surrounded by a well-defined ulcer mound on the posterior wall of the lower body. Fusion of folds converging from the oral side of the lesion was well demonstrated on the double contrast views. Gastrectomy was performed with a preoperative diagnosis of Borrmann type 2 advanced cancer.

　There was no doubt in making a macroscopic diagnosis of Borrmann type 2 advanced cancer 20×15 mm, but unexpectedly the histological examination showed that the infiltration of moderately differentiated adenocarcinoma was limited to the submucosal layer. Furthermore, marked hyperplasia of lymph follicles was microscopically observed in the submucosal layer. Retrospectively, misinterpretation of the morphological findings of this lesion was caused by these co-existent lymph follicles in the submucosal layer.