術前の深達度診断が困難であったⅠ型早期胃癌の1例

Early Gastric Cancer, Type Ⅰ, Difficult to Diagnose Its Correct Depth of Cancerous Infiltration Preoperatively, Report of a Case

　胃の隆起型胃癌の術前の深達度診断は，ある程度正確に行えるようになっている．われわれは術前のX線および内視鏡診断にてBorrmann 2型癌と診断し，術後の病理組織学的検索にてⅠ型早期胃癌であった1例を経験したので，その深達度診断について若干の文献的考察を加え報告する．

　A 59-year-old woman was admitted to Kitasato University Hospital with the chief complaint of weight loss (6 kg/2 M). Complete blood count showed anemia (Hb 8.1 g/dl, RBC 369×10⁴). X-ray study of the upper digestive tract demonstrated a protruded lesion (4.5×3.6 cm in diameter) with irregular deep depression but without fold convergence on the lesser curvature of the antrum. This tumor was elevated sharply making a waist at the base of it. Endoscopic findings revealed almost the same as those of x-ray. In addition to it, surface of the tumor was discolored, and there was no white coating at the depressed site. According to x-ray and endoscopic findings, Borrmann Type 2 advanced cancer was diagnosed initially. Grossly, the size of the protruded lesion was 3.8×3.6 cm in diameter and no fold convergence was seen. Histological examination of the resected specimen showed moderately differentiated adenocarcinoma and the depth of infiltration was limited to the submucosa. At the central depression of the tumor, there was no ulcerative changes. Therefore, finally we diagnosed it as Type Ⅰ early gastric cancer.