広範なⅡa＋Ⅱb型早期癌の1例

ONE CASE OF A WIDE SPREAD Ⅱa+Ⅱb TYPE EARLY GASTRIC CANCER.

　間接X線検査で小さなⅡaを診断することはきわめて困難な問題である．本例は幸いに後壁大彎側を主とした大きなⅡa型早期癌で間接X線写真の辺縁不整，伸展不良の所見から見逃しをまぬがれた．

　The patient had no complaint. This case was diagnosed as Ⅱa+Ⅱb type gastric cancer by the irregularity of the wall at pylorus appeared on the X-ray film taken at the group stomach examination.

　The patient was sixty-two year old male and joined the anti-cancer society taking the opportunity of his father's death by gastric cancer. Abnormal change was pointed out by the group stomach examination in the same year and a close examination was made in our clinic. There were no abnormal findings in blood examination, blood sedimentation test and feces examination. Gastric juice showed achlorhydria by histamin test. By X-ray examination, irregularity of the wall and rigid part at the greater curvature of the pylorus were noticed. Winding green caterpillar like elevation was noticed by the double contrast method at the same part. By endoscopical examination, a continuous, partly nodular, flat and uneven elevation was noticed. This change was not restrictive and the mucous fold shifted to the elevation continuosly. Diagnosis as Ⅱa was made recntogenologically and endoscopically but it was difficult to clifferenciate it from a non-carcinoma elevation. In this case, cytological examination and biopsy under direct view were both positive and the sure diagnosis was made preoperatively. Post operative examination revealed not only the cancer at the elevated part but the wide spread Ⅱb type cancer.