術前Ⅱc類似進行胃癌と診断され，術後3年目に再発死亡したⅡc型早期胃癌（深達度sm）の1例

Early Gastric Cancer, Type Ⅱc (sm), Misdiagnosed as Advanced Cancer Simulating Type Ⅱc, Whose Patient Died of Cancerous Recurrence Three Years After Operation, Report of a Case

　術前にⅡc類似進行胃癌と診断され，術後3年目に再発死亡したⅡc型早期胃癌（深達度sm）の1例を報告する．

症例

　患　者：46歳，男，自営業．

　主　訴：空腹時心窩部痛．

　家族歴：特記すべきことはない．

　既往歴：30歳のときに虫垂切除術を受けた．

　現病歴：1971年4月ごろより，空腹時の心窩部痛が間歇的に出現するようになった．同年9月近医を受診し，胃X線検査を受けた結果，十二指腸潰瘍と診断され投薬を受けた．症状は一時期消失したが，翌年の6月ごろより上記症状が再発したため，再び同医を受診して胃X線検査を受けたところ胃の変形を指摘され，精密検査を勧められた．同月某大学病院にて精密検査を受け，手術したほうがよいと言われた．同年7月5日に癌研外科を受診し，8月17日に入院した．空腹時の心窩部痛は断続的に入院時まで続いた．

　A 46-year-old man suffering from epigastralgy when hungry came to our hospital to undergo an operation.

　In the x-ray findings a defined and deeper depressed lesion surrounded by mucosal elevation was observed accompanied with converging mucosal folds in a shallow depression. Diagnosis as advanced cancer simulating type Ⅱc was made.

　Endoscopically, this lesion was finally diagnosed as advanced cancer similar to type Ⅱc+Ⅲ (pm), and the surrounding mucosa was edematous.

　An operation (R₃) performed on October 25, 1972 resulted in only relative curative resection because cancerous metastasis to lymph node (N₃) was found.

　The lesion measuring 6.0×5.5 cm was proved to be type Ⅱc (sm) accompanied with Ul-Ⅲs and cancerous invasion to intramural lymph duct and vessel. The part of sm infiltration measured 2.5×1.0 cm.

　Postoperative prognosis depends upon the dimension of sm infiltration, the degree of invasion to submucosal lymph vessels and histological type of cancer.