潰瘍瘢痕部のみに深部浸潤したⅡc類似進行胃癌の1例

Ⅱc-like Advanced Carcinoma with Deep Invasion at the Ulcer Scar

　陥凹性胃癌の深達度診断は以前より多数の報告があり，ほぼ研究され尽した感がある．しかしながら現在の診断基準でも，まだ正確な深達度診断の不可能な症例もあり，まだまだ検討の余地を残していると思われる．今回われわれは，陥凹性病変で術前の胃X線・内視鏡像にて早期胃癌を強く疑ったが，組織学的に深達度seの症例を経験したので報告する．

　A 33-year-old woman with chief complaint of epigastralgia was admitted to our hospital. She was diagnosed as Ⅱc type early gastric cancer with submucosal invasion by means of x-ray and endoscopic examinations. But pathological features of the resected stomach showed poorly differentiated adenocarcinoma which invaded focally the serosal surface at the ulcer scar. Such as this, it is difficult to judge the deep invasion of carcinoma with ulcer scar accurately. Accordingly, the correlation between existence of ulcer scar in carcinomas and invasion of carcinoma was investigated in this study.

　We investigated 200 cases of the Ⅱc-like advanced type carcinomas. The cases with ulcer scar were observed in 45 cases of 100 sm-carcinomas, in 30 cases of 50 m-carcinomas and in 28 cases of 50 Ⅱc-like advanced type carcinomas. The cases with submucosal invasion were classified into three types, i,e, A type: carcinoma cells are focally found in the upper part of the submucosal layer, B₁ type: they are scantly distributed in the whole submucosal layer, B₂ type: they densely occupy the whole submucosal layer.

　In 15 sm-carcinomas and 8 Ⅱc-like advanced type carcinomas, deep invasion was recognized only at the ulcer scar. Out of these cases, an accurate invasion could be diagnosed only in the cases of B₂ type. But it was difficult to make accurate diagnosis in the cases of A type and B₁ type as well as in the cases of Ⅱc-like advanced type carcinoma which cells scantly exist in the proper muscle layer such as the case presented in this study.

　In diagnosis of gastric carcinoma with ulcer scar, we must be careful of the deep invasion particularly at the ulcer scar.