Ⅱc＋Ⅲ型早期癌類似進行癌と術前診断したsm胃癌の1例

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

　術前にⅡc＋Ⅲ型早期癌類似進行癌と診断したsm胃癌の1例を報告する．

症例

　患　者：53歳，男，会社員．

　現病歴：3～4年前より上腹部痛あり．近医で胃潰瘍の診断にて投薬を受けていたが，痛みは軽快しなかった．1978年12月当科紹介され，入院した．

　A 53-year-old man came to our department with a complaint of upper abdominal pain. A barium meal study showed opening of the gastric angle and an irregular-shaped area of depression with nodular bottom at the gastric angle. Clubbing or abrupt interruption of the tip of the converging mucosal folds were also visualized. At gastroscopy, an irregular-shaped deep white-coated depression with nodular bottom was also well observed. Gastrectomy was performed with a preoperative diagnosis of Ⅱc+Ⅲ like advanced cancer.

　Ulcerative cancer, measuring 6.0×6.0 cm, was seen in the resected specimen and it histologically consisted of a mixture of signet-ring cell carcinoma and moderately differentiated adenocarcinoma. Most of cancerous infiltration was limited to the mucosa, but small amounts of cancer cells was microscopically identified in the submucosal layer. A linear ulcer of Ul-Ⅲ or Ⅳ degree about 7 mm in length was recognized inside the cancerous focus with marked fibrosis under the submucosal layer. Thus, difficulty often arises in interpretation of wall stiffness caused by cancerous infiltration or by fibrosis due to benign ulcer.