6か月間逆追跡資料の得られた浸潤型Ⅱc類似進行胃癌の1例

Infiltraive Carcinoma of the Stomach Retrospectively Traced up to Six Months, Report of a Case

要旨　患者は72歳，女性．主訴は心窩部痛．胃内視鏡検査で胃体部大彎に境界明瞭な膨れた不整な粘膜像を認め，胃X線像では皺襞集中を伴わないⅡc様陥凹と壁の硬化を認めた．組織学的にはUl(－)の胃底腺粘膜に囲まれた未分化型癌で，浸潤型発育をしたⅡc類似進行胃癌であった．本例はlinitis plastica型胃癌のまだ完成していない，杉山ら⁴⁾のいうpre-linitis plasticaと考えられる．このⅡc類似進行胃癌の更に6か月前の胃X線像は，胃体部大彎のⅡc様所見であった．

　A 72-year-old woman visited our hospital with the complaint of epigastric pain. Endoscopic examination revealed irregular and swollen mucosa, resembling Ⅱc, on the greater curvature of the upper body (Fig. 2). The gastric x-ray showed irregular and coarse mucosa as well as stiff wall of that portion (Fig. 1). Total gastrectomy was carried out under the diagnosis of early gastric cancer. Histologically intramucosal cancer was found in the fundic gland (Figs. 3 and 4). There was no ulcer. Underneath the mucous membrane poorly differentiated cancer cells were infiltrating down into the subserosa. Submucosal spread of cancer was more than twice in degree than that in the intramucosal layer (Fig. 5). This case was equivalent to "pre-linitis plastica" reported by Sugiyama et al, with submucosal infiltration not exceeding one-fourth of whole area of the stomach. X-ray picture taken 6 months before operation were retrospectively studyed (Figs. 6 and 7). Early stage of linitis plastica was shown as type Ⅱc without convergence of mucosal folds on the greater curvature of the body.