粘膜下層浸潤の診断が困難であったⅡc型早期胃癌の1例

Small Early Gastric Cancer, Type Ⅱc, Difficult to Diagnose Its Submucosal Invasion Correctly

　早期胃癌の深達度診断には多数の業績があるが，小胃癌のそれに関する報告は少ない．われわれの経験した前壁の比較的小さいⅡc症例を呈示し，小胃癌の深達度診断について若干の考察を加える．

　A 54-year-old man having no complaints visited Health Science Center of Kitasato University Hospital for health check on August 3, 1972. Upper gastrointestinal series showed slight widening of the gastric angle. Endoscopic examination on September 1 revealed abnormal reddening of the anterior wall of the middle corpus. Biopsy specimen taken on September 20 revealed adenocarcinoma. Macroscopic findings of resected stomach showed a shallow depressed lesion (1.6×0.9 cm in diameter) without converging mucosal folds at the anterior wall of the middle corpus. Histologically, moderately differentiated adenocarcinoma which limited in this depressed area, invaded the submucosal layer in some part.

　Comment: In small depressed type of early gastric cancer it is sometimes difficult to estimate the depth of cancerous invasion. We think the hallmark of submucosal cancerous invasion of depressed type of early gastric cancer without converging mucosal folds is as follows.

　X-ray findings: the width of moth-eaten appearance and size of radiolucency around depressed lesion.

　Endoscopic findings: size of nodular protrusion around depressed lesion and with or without plateau-like appearance. This case lacked these findings, so that estimation of the degree of vertical cancerous invasion was difficult.