線状潰瘍瘢痕を伴う胃潰瘍の辺縁に限局した小胃癌の1例

Small Gastric Cancer Adjacent to a Gastric Ulcer Arising in a Linear Ulcer Scar, Report of a Case

要旨　患者は53歳女性．1978年から胃潰瘍の再発を繰り返す．1990年9月心窩部痛，吐・下血が出現．胃X線検査で巨大潰瘍を指摘され当院を受診，内視鏡検査で胃角部の小彎を中心とした長い線状潰瘍瘢痕の前壁側端に，長径30mm強の楕円形の潰瘍を認めた．潰瘍の辺縁はほとんど全周で平滑であるが，潰瘍の肛側辺縁に浅い陥凹のはみ出し様の所見があり，この外縁からの生検組織に癌を認めた．内視鏡所見を見直すと，この陥凹の肛側に接して長径5mm弱の褪色域が描出されていた．約2か月後の内視鏡検査では，潰瘍は縮小しているが褪色域は拡大しており，明瞭なⅡcを形成していた．切除標本では陥凹のはみ出しに癌はなく再生上皮で覆われ，この外側に長径8mmのⅡbを示す粘膜内に限局した管状腺癌が認められた．潰瘍の治癒機転により潰瘍の辺縁に再生膜が伸び，潰瘍の辺縁は癌から離れるに至ったと推測される．

　A 53-year-old woman, who had suffered from recurrent gastric ulcer for previous twelve years, visited our hospital because of a giant gastric ulcer found by x-ray studies. Endoscopy showed a gastric ulcer more than 30mm in diameter in the anterior wall of the gastric angle, at the end of a long linear ulcer scar. Almost whole margin of the ulcer was smooth, but a small irregular depressed lesion was recognized at its anal side. Biopsy specimens taken from the margin of this depressed lesion revealed cancer cells. Review of the endoscopic findings retrospectively showed a discolored area less than 5mm in diameter adjoining to the irregular depressed lesion. Histological examination of the resected specimen showed that the irregular depressed lesion did not contain any cancer cells and was covered with regenerative mucosa. Adjacent to the regenerative mucosa a Ⅱb lesion measuring 8mm in diameter was observed. The histological diagnosis was as being tubular adenocarcinoma and the lesion was limited within the mucosa. It was suggested that the ulcer margin had been separated from the cancer focus by extending regenerative epithelium during the process of ulcer healing.