生検で確認できたⅢ型早期胃癌の1例―良性所見の胃潰瘍に対する生検に関連して

Type Ⅲ Early Gastric Cancer Detected by Biopsy, a Case Report: Importance of biopsy even for gastric ulcer with benign appearance

　良性所見を呈する胃潰瘍とⅢ型早期胃癌の鑑別は日常臨床上きわめて重要である．生検により診断し得た潰瘍辺縁の一部に偏在性に微小癌を有するⅢ型早期胃癌を経験したので報告するとともに良性潰瘍に対する生検の意義について考察を加える．

　A 40-year-old man had been suffering from epigastric pain for several years, especially when he had been hungry. Two years ago he was treated for 3 months under a diagnosis of benign gastric ulcer. He felt much better then. Recently, however, he felt the same kind of epigastric pain, so that he was examined both roentgenologically and endoscopically. At first their results led to a diagnosis of a benign gastric ulcer at the angulus, but later the ulcer was confirmed as type Ⅲ early cancer because one of seven biopsied specimens taken from the surrounding areas of the ulcer finally revealed adenocarcinoma mucocelleclare. Histologic study of the resected specimens also disclosed adenocarcinoma mucocellulare at a small spot on the border of the ulcer, which was Ul-Ⅳ in depth. As many similarities of patterns between benign ulcer and type Ⅲ early cancer make it not always easy to differentiate between the two, it seems very important clinically to apply gastric biopsy even to ulcer with benign appearance.