手術8ヵ月前に細胞診のみ陽性であったII_b型早期胃癌の一例

抄録

A small lesion of type IIb early gastric cancer was diagnosed by cytologic examination using the lavage method. The patient was a 72year-old male with gastric ulcer. He was being treated for an ulcer in the gastric angle, which had been diagnosed by upper G-I series, endoscopy and biopsy. Four months after the first upper G-I series, cytologic examination using the lavage method revealed typical malignant cells. Following the detection of the malignant cells, frequent examinations of upper G-I series and endoscopy were performed;however, no abnormal findings were achieved except for the ulcer in the gastric angle. No carcinoma was found in the biopsy specimens derived from the ulcer and the mucosa adjacent to it.
He underwent subtotal gastrectomy 8 months after the detection of malignant cells, because of possible carcinoma other than the ulcer. Gross findings of the resected stomach appeared quite normal except the ulcer. But, histopathologically, carcinoma was found in the anterior wall far from the ulcer. Histologically it was an adenocarcinoma tubulare confined to the mucosal layer, 8×4mm in size.
This case suggested that it is quite difficult to diagnose a type II_b early gastric cancer by the methods of upper G-I series and endoscopy, and the cytologic examination using the lavage method may play an important role in the diagnosis.