術前の深達度診断が困難であったⅡc＋Ⅲ型早期胃癌の1例

Early Gastric Cancer, Type Ⅱc+Ⅲ, Difficult to Diagnose Preoperatively in Its Correct Depth of Cancerous Infiltration

　陥凹型胃癌の深達度診断については，肉眼像のみならず，X線・内視鏡的に多くの研究がなされ，ある程度的確な術前診断が行えるようになってきている．今回，われわれは術前に粘膜下層（sm）まで浸潤したⅡc＋Ⅲ型早期胃癌と考えたが，術後の病理組織学的検索により，粘膜内（m）に限局し発育した早期癌であった1例を経験した．本症例の診断学的問題点について若干の文献的考察を加え報告する．

　A 44-year-old woman was admitted to Kitasato University Hospital because of epigastric pain in April 1974. Radiological examination of the stomach demonstrated an irregular shallow depression with fold convergence on the greater curvature of the angle. Converging mucosal folds showed abrupt interruption, swelling, moth-eaten appearance and fusion of the tips. Almost the same findings were seen by the following endoscopical examination. In addition, significant elevation of this lesion as a whole was pointed out endoscopically. Preoperative diagnosis of Ⅱc+Ⅲ type gastric cancer having the infiltration depth into the submucosal layer was made. She was operated on one month after admission. In gross appearance of the resected stomach, an open ulcer (0.5×0.5 cm in diameter) was seen in the center or a shallow depressed lesion (2.5×1.5 cm in diameter). Histological examination showed signet-ring cell carcinoma and the invasion was only limited to the mucosal layer. Submucosal fibrosis accompanied by the ulceration was marked and no cancer tissue was scattered in it. This prominent ulcer-related fibrosis misled us to overestimate the depth of cancer invasion.