Ⅲ＋Ⅱb型早期胃癌例

ONE CASE OF Ⅲ+Ⅱb TYPE EARLY GASTRIC CANCER.

Ⅰ．はじめに

　早期胃癌の診断は，X線検査，内視鏡検査の著しい進歩により1cm前後の表面型早期胃癌まで可能となって来た．そして今後早期胃癌診断の方向は，更に小さい病変，およびより凹凸の少ない即ちⅡb病変の診断へと向って行くものと思われる．このような病変の診断にはX線検査，内視鏡検査のみでは確診に到るには困難であり，当然のことながら胃生検，細胞診などの病理学的水準での診断の協力が必要となって来る．

　私共は2年9ヵ月間経過観察を行ない，最終的には胃生検によりⅢ＋Ⅱb型早期胃癌と診断した例を経験した．この症例はあらかじめ胃生検で，癌であることが確認されていてその後のX線検査で潰瘍周辺の胃粘膜の状態を検討した例である．

　It has become possible to diagnose the Ⅱc type and Ⅱa type early gastric cancer which are of more than 1 cm-2 cm spread if good X-ray photograph is taken and strict inspection of this photograph is made. However it is still left to be solved to diagnose superficial gastric cancer less than 1 cm and the Ⅱb type gastric cancer. The observation of the ulcer at angulus and ulcer like change to the greater curvature on the opposite side was made for the period of 2 years and 9 months. Finally cancertissue was proved by biopsy. The diagnosis of Ⅲ+Ⅱb type early gastric cancer was made by referring to the findings by X-ray. Even if the diagnosis of gastric cancer has been made before hand, and even by taking many photographs, it is very difficult to make it sure only by X-ray ray examination. It is necessary to undertake biopsy or cytological examination besides X-ray examination. X-ray examination is the routine examination undertaken for gastric disease, but at the same time it is an exact and final exam. from the viewpoint that it can obtain the same result as an operated specimen. The operated specimen was and 2×2.5cm in its spread. X-ray photograph showed a shallow niche with an amoeba like shadow around it at greater curvature. This shadowy part was recognized as an area gastricae different from normal area gastricae and had sligh unevenness and irregularity. That is why the case was doubted as being cancer.