<Case Report>A Case of Early Gastric Carcinoma with Acute Gastric Mucosal Lesions Presenting Difficulty in Differentiating Advanced Gastric Carcinoma

Abstract

An 87-year-old man diagnosed as having advanced gastric carcinoma was admitted to our hospital. In a barium X-ray examination of the stomach taken at another hospital, filling defects were obseved in the greater and lesser curvatures of the antrum, while the entire pyloric region was rigid and stenotic. The gastroscopic findings showed pronounced curvature and stenosis of the pylorus and the pyloric mucosa was edematous and sclerotic. Histopathological examination of a biopsy specimen from the pylorus indicated a group V The gastroscopic findings subsequent to admission displayed pronounced improvement with only sporadic shallow ulceration and erosion. The histopathological findings of the excised specimen showed that several depressed lesions in the antrum were active ulcers or their scars and the depressed lesions extending from the antrum to the pyloric ring were early gastric carcinoma. The findings of filling defects of the antrum and stenos is with ridigity of the pyloric region in the radiographic examination, and pronounced curvature and stenosis of the pylorus and sclerosis with edema of the pyloric mucosa in the gastroscopic examination were very similar to typical findings of advanced gastric carcinoma with pyloric stenosis. In addition, histopathological examination of a biopsy specimen from the pylorus indicating a group V made differentiation from advanced gastric carcinoma extremely difficult.

急性胃粘膜病変（AGML）は粘膜炎といった表層性所見のほかに, 筋層炎または胃壁全層の炎症ため, 胃X線検査や内視鏡検査により進行胃癌との鑑別に難渋することがある. 今回, 早期胃癌にAGMLが併存したため, 進行胃癌との鑑別が困難であった1例を経験したので報告する. 症例は82歳の男性. 老人検診で胃X線検査および内視鏡検査を施行され, 胃癌の診断で当科に入院となった. 胃X線検査では, 立位充満像で幽門部大弯および小弯側に陰影欠損が認められ, 幽門部全体は硬直し, 幽門狭窄の状態であった. 胃内視鏡検査では, 幽門前庭部は強く屈曲し狭窄しており, 幽門粘膜は浮腫状で硬く, 前壁側に広く浅い潰瘍が広がっており, 所々に出血斑が認められた. 幽門前庭部からの生検でgroup V が得られた. 以上の所見より, 幽門狭窄を伴った Borrmann 3型進行胃癌の診断で当科に入院となった. 入院後, 初回の内視鏡検査から3週目に施行された胃内視鏡検査では, 幽門粘膜に軽度の硬さが残存しており, やや壁の伸展不良が認められたものの, 浮腫状変化は著明に改善しており, 所々に浅い潰瘍やびらんが散在しているのみであった. 幽門前庭部前壁のらんから, 印環細胞癌の診断が得られた. 以上の成績より, AGML に併存した早期胃癌と診断し, 広範胃切除術, D_1 リンパ節郭清を施行した. 本症例は, 早期胃癌に AGML が併存したため, 幽門狭窄を伴った Borrmann 3型進行癌との鑑別が困難な1例であった.