非定型的Ⅱc＋Ⅲ型早期胃癌の1例

A CASE OF EARLY GASTRIC CANCER, ATYPICAL Ⅱc PLUS Ⅲ

Ⅰ．緒言

　早期胃癌のなかでもⅡc＋Ⅲ型はすでに診断容易なものとなっており，今日の早期胃癌診断学の興味の焦点からはずされている感がないでもない．しかし非定型的な揚合には依然としてX線，内視鏡診断上なお多くの問題を残している．

　われわれは，胃集団検診で胃潰瘍を発見され，内視鏡検査で早期胃癌Ⅱc＋Ⅲと診断，生検で癌と確診した手術例において，その肉眼所見は普通のⅡcと異なり陥凹の周界がやや不明瞭であり，病理組織学的にも癌の拡がりは陥凹に一致していなかったという非定型的なⅡc＋Ⅲ型早期胃癌を経験したのでその概要を報告する．

　Patient: male, 51 years of age.

　Stomach ulcer was detected at the time of mass examination of the stomach, and the patient was referred to for thorough check-up.

　Though for a relatively short period, X-ray and endoscope were employed for follow-up study, and two ulcers were easily detected above the gastric angle. Depression resembling Type Hc was seen in the surrounding area, but the ulcer soon healed, thus leaving the image of healing ulcer amidst the Type Ⅱc depression.

　By the gross observation of the excised stomach, it turned out to be quite different from ordinary Type Ⅱc, since the margin was rather indistinct and pathohistologically the extent of cancer did not coincide with the area of depression. Thus this was a case of early gastric cancer (carcinoma mucocellulare simplex), quite distinguishable from ordinary Type Ⅱc in that it is found only in the margin of the depression. It is termed atypical because the margin of depression was obscure for the most part, making it difficult to trace the extent of cancer by macroscopical obser vation.

　Among many cases of early gastric cancer reported these days, the combination of Types Ⅱc and Ⅲ is rather common and easy to diagnose, being, as it were, out of focus in the diagnosis of early gastric cancer, but when it is atypical as in this case, there still remains many problems as to X-ray and endoscope observations.

　It is every clinician's responsibility to examine each cancerous case in detail, and not to discard the orthodox approach for diagnosis in the process of examination.