吐下血で発症し経過観察中生検陰性であった噴門部sm癌の1例

Early Gastric Cancer in the Cardia Having Difficulty in Making Definite Diagnosis, Report of a Case

要旨　患者は65歳，男性．2年前から脳梗塞のために抗凝固剤を服用中であった．吐下血が出現し初回の内視鏡検査で噴門部小彎後壁に出血性胃潰瘍が認められ，内視鏡的止血術が施行された．その後6回の内視鏡検査と3回の生検が行われたが，組織学的には悪性所見は認められなかった．経時的な内視鏡検査による観察で不整な潰瘍がみられ，X線所見と合わせて悪性と診断し噴門部胃切除術を施行した．切除標本の病理組織学的検索の結果，Ul-Ⅱsの後壁側に1.0×0.8cmの高分化型腺癌が認められ，深達度smのⅡc型早期胃癌と診断された．生検組織診断が陰性であっても，十分な経過観察とX線・内視鏡検査による綿密な観察が重要であることが示唆された噴門部早期胃癌の1例を報告した．

　A 65-year-old man had taken anticoagulant therapy for two years because of his multiple brain infarcts. He suddenly developed hematoemesis and tarry stool. Endoscopic examination showed a hemorrhagic gastric ulcer on the posterior wall of the cardia. Endoscopic injection for hemostasis was done successfully. Three months later, gastrofiberscopic examination revealed an irregular-shaped ulcer with coating. X-ray examination showed faint barium spots around the linear ulcer. Although radiological and endoscopical features highly suggested a gastric cancer, the biopsy specimen did not confirm the diagnosis. Proximal gastrectomy was performed, since the possibility of malignant neoplasm could not be clinically ruled out. The histopathologic examination of the resected specimen revealed well differentiated adenocarcinoma, measuring 1.0×0.8 cm in size. Cancer cells infiltrated into the submucosa adjacent to the ulcer scar. Even if histopathological examination of the biopsy specimens does not prove to be malignant, we should pay much attention to the patient with a suspected ulcerated gastric cancer and follow-up the lesion carefully.