Ⅱb型早期胃癌の2症例および本邦におけるⅡb型62例の考察

Two Cases of Early Gastric Cancer of Superficial Flat Type (Ⅱb) with Stastical Analysis of Ⅱb Cases Hitherto Reported in Japan

　X線，内視鏡検査をはじめ，生検，細胞診などの診断技術の進歩により，早期胃癌の診断はかなり容易となったが，Ⅱb型早期胃癌に関してはいまだその手懸りに乏しい．著者らは最近併存した他病変のため胃切除を行ない，たまたまそれに接して発見されたⅡb型の2症例を経験したので，本邦において報告されている60例と併せ，計62例について考察を加えた．

　Case 1: A 63-year-old woman was admitted to our medical institute with colicky epigastric pain. At x-ray examination, a Ⅱa type protruded lesion was suspected on the lesser curvature of the gastric angle. Endoscopic study revealed a low mucosal elevation of irregular shape located from the lesser curvature over to the posterior wall above the angle. The lesion was endoscopically suspected as Ⅱa type early cancer. By the examination of the resected specimen, a Ⅱa type protruded lesion was proven in the same site as in the endoscopic picture, with another Ⅱb type lesion located on the anterior wall at the level of the angle. Histologically, these two lesions were diagnosed as early gastric cancers (Ⅱa＋Ⅱb: papillotubular adenocarcinoma).

　Case 2: A 62-year-old man was admitted to our institute because of repeated hematemesis. At x-ray examination, a deep ulcer was found on the lesser curvature of the middle part of the body. Endoscopic study revealed an oval-shaped ulcer with thin surrounding wall in the same area as in x-ray. The mucosal folds converging from the anterior wall were interrupted. In the resected specimen a deep ulcer (Ul-Ⅳ) was found on the lesser curvature of the body. On histological examination, early gastric cancer of Ⅱb＋Ⅲ type (tubular adenocarcinoma) was located in the area anterior to the ulcer.

　Stastical analysis was also made on 62 cases of Ⅱb type early gastric cancer hitherto reported in Japan.

　Careful, combined studies of x-ray and endoscopy should improve correct diagnosis rate of Ⅱb type early gastric cancer.