早期癌類似進行胃癌と術前診断した深達度smのⅡc型早期胃癌の1例

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

　X線および内視鏡で，術前に進行癌と診断されたが，切除標本では深達度smであったⅡc症例を呈示する．

症例

　患　者：70歳，男，大学教授．

　主　訴：上腹部痛．

　家族歴：特記すべきものなし．

　既往歴：1974年11月に前立腺肥大で，本院泌尿器科にて手術を受ける．また，数年来，痛風にて治療を受けている．

　The patient, a 70-year-old man, complained of epigastralgia since March 1974. Routine upper GI series performed on March 10, 1975, revealed an abnormality suggesting gastric cancer. Preoperatively he was diagnosed to have advanced cancer simulating type Ⅱc by means of minute x-ray examination and endoscopic study. Findings were marked deformity of the antrum and double-contoured depressed lesion, and this depressed area was noticed in plateau-like elevation. Partial gastrectomy was carried out on April 9, 1975. Histological examination was proved to be undifferentiated adenocarcinoma. The size of the lesion was 6.5×3.5 cm and the lesion had double contour. A linear scar (Ul-Ⅱ) was identified within the inner, deeper depression. Cancerous involvement was limited in the submucosal layer.

　Retrospectively, the marked deformity of the greater curvature and the plateau-like elevation were considered to be caused by the linear scar and submucosal fibrosis. If the linear scar had been recognized, preoperatively we might have been able to diagnose this patient as early gastric cancer.