異型上皮と低いⅡa＋Ⅱc（一部非癌性）とが，独立して胃前壁に存在した1例

A Case of Atypical Epithelium and Low Ⅱa+Ⅱc independent from each other and yet seen both on the Anterior Wall

Ⅰ．症例

　患者：S. S.　47歳　男

　主訴：胃集検で要精検とされたため，精検を希望して来院

　現病歴：1969年11月15目に胃集検をうけ，前庭部に変形ありとされ，要精検とされたため，精検を希望して来院したが，自覚的にはなにも訴えなかった，

　既往歴：著明な疾患はない．

　家族歴：祖父は病名不明のまま死亡したが癌は否定されていない．祖母は胃癌で死亡．父は67歳で胃癌で死亡．弟は胃癌で死亡．長男は胃癌で死亡．母は現在健康であり，癌の遺伝はないようである．しかし，癌で死亡した人が家系の中で多いといえる．

　A 47-year-old man visited the authors' hospital for thorough check-up of his stomach because at a gastric mass survey he had been suspected to harbor an abnormality there. X-ray revealed two lesions on the anterior wall at the height of the gastric angle. The one located near the lesser curvature was an irregular-shaped elevation formed like an atypical dumbbell, while the other, a low protrusion of also irregular shape situated in the center of the anterior wall at the angle, presented a picture as if two chrysanthemum-petals had fused into one.

　The former was easily detected by endoscopy, while the other was recognized only indistinctly.

　The resected stomach revealed the former to be an atypical epithelium and the latter, intramucosal carcinoma. Diffuse intestinal metaplasia was observed in the antrum.

　Renewed interest was aroused by the present case because it seemed to show that the examiner must always be on guard against any overlooking of latent multiple lesions; that the anterior wall must be visualized to the best advantage; that strict distinction is necessary between gastritic changes and cancer; that endoscopic diagnosis of low elevations less than 1. mm in height is not so easy; that only after due evaluation of x-ray and endoscopic findings should one have recourse to minute biopsy and finally that even in an apparent Ⅱa+Ⅱc-like lesion does a non-cancerous portion exist.