深達度の判定が困難であった小進行胃癌の臨床診断

Clinical Diagnosis of Small Advanced Cancer, Report of a Case

　胃癌をより早期に見付けようとする努力の結果，より小さい胃癌も発見されるようになってきている．1978年秋の消化器病，内視鏡，胃集検学会合同大会のシンポ“微小胃癌をめぐって”においても5mm以下および10mm以下の胃癌の形態的特徴が検討されている．しかし，その深達度判定については，いまだ十分な結論は得られておらず，大部分がm，smの早期胃癌である．ただまれにpm浸潤の報告がみられる程度で，小進行胃癌の形態は明らかにされていない．最近，われわれは術前に小早期胃癌と診断したが，組織学的にはssまで浸潤していた小進行胃癌を経験した．更にその近傍に3個の小潰瘍がみられ，鑑別を要したので併せて報告する．

　In a 58-year-old man, one gastric cancer and three gastric ulcer were found by the x-ray examination and the endoscopic examination. This gastric cancer, 10×10 mm, located mainly in the submucosa, and exposed only 5×5 mm on the mucosal surface. By clinical examination, this lesion was observed as a small stellate depression surrounded by elevation. The anterior and the oral side of the elevation was granular. But the other side was recognized relatively smooth and of high elevation. In this point, cancerous tissue infiltrated the subserosal layer. This lesion was easily diagnosed as malignancy, but it was difficult to diagnose the grade of cancerous invasion. It seems that the findings of smooth surface on the oral side and the posterior side of elevation and the compression picture were the clue to the diagnosis of the invasion.

　Three ulcers were situated on both the posterior wall and the anterior wall of the lower body, and the posterior wall of the middle body. These lesions were shown as tiny depressions surrounded by nodular elevation. But this nodular elevation easily disappeared by the compression study. It seems that this finding is difference from that of cancers.