類似Ⅱb型早期癌の1例

Ⅱb Type Early Gastric Cancer, Report of a Case

　早期胃癌の診断にとって，いわば最終目標として示されたⅡb型早期胃癌もその後の診断学的努力により幾多の報告がなされるに至っている．しかし，病理組織学的検討にもたえる厳密なⅡbは中村の報告によれば，5mm以下の微小胃癌にしか存在せず，そのようなⅡbの診断は臨床上未だ不可能に近い．

　現在，臨床診断の対象になっている症例の多くは類似Ⅱbあるいは随伴Ⅱb症例であり，X線および内視鏡所見の検討もある程度の拡がりをもつ“いわゆるⅡb型早期癌”についてなされているが，診断基準確立までには至らず生検による組織診断により確診されているのが現状であろう．

　Cancer of the stomach was diagnosed in a man aged 62 by biopsy, who was subsequently examined in detail by both X-ray and endoscopy. It was a Ⅱb type early cancer at the angulus.

　In double contrast picture with small amount of barium meal and air poor distensibility of the lesser curvature was noted, while in that with sufficient amount of air and well-distended lumen, irregular granular appearance of the mucosa was depicted along with abnormal barium coating.

　Endoscopy revealed slight deformity of the angle and rugal convergency, showing discoloration as in atrophic gastritis. We were unable to cover the whole extent of abnormality, however.

　Macroscopically, the resected specimen showed a discolored area, of yellowish white color, centering on the angle. The granular appearance in this part was slightly irregular. Histologic diagnosis of this part was adenocarcinonoma mucocellulare, but macroscopically it was impossible to determine the border of cancer extension.

　Transverse sections of the histologic specimens showed in some of cancer regions slight niveau difference when examined microscopically, but grossly there was hardly any difference in mucosal height. Hypoacidity in gastric analysis and prominent intestinal metaplasia in the antral mucosa has led us to assume that the present lesion must have remained in a state of Ⅱb type until it has spread out to a relatively wide area.