蛋白漏出が疑われたBorrmann1型胃癌の1例

Borrmann 1 Type Gastric Cancer with Remarkable Protein Loss, Report of a Case

要旨　著しい低蛋白血症を伴った胃癌の1例を経験した．大量腹水貯溜を主訴とし，血清総蛋白3.7g/dlと著明な低蛋白血症を呈していた．患者は長期のアルコール飲酒歴を有していたが，肝硬変はなかった．腹水中にも悪性細胞を認めず，癌性腹膜炎は否定された．これらより，アルコール依存のための低栄養状態と考え高カロリー輸液を施行したが低蛋白血症は改善せず，胃癌よりの蛋白漏出性胃症が強く疑われたため胃癌根治術を施行した．胃切除後，血清蛋白は術後1週間で7.7g/dlと著明な改善をみた．組織学的には，腫瘍表面全体が活動性の潰瘍底と同様の変化を呈し，炎症性滲出液の喪失による低蛋白血症を来したと思われる．

　The case is of a 57-year-old man with marked ascites, diarrhea and edema of the extremities. Until his admission to our hospital he had been drinking heavily. Laboratory examinations on admission revealed severe hypoproteinemia (serum protein 3.7 g/dl, serum albumin 1.4 g/dl), but liver cirrhosis was denied by laboratory examinations, ultrasonic examination and computed tomography of the liver.

　X-ray and endoscopic examination of the stomach revealed large Borrmann 1 type gastric cancer, and cytological examination of ascites ruled out peritonitis carcinomatosa. In spite of total parenteral nutrition, his hypoproteinemia did not improve at all.

　Then, we came to the conclusion that the hypoproteinemia of this patient was induced by protein loss from the surface of the tumor in the stomach and we performed distal gastrectomy. After this operation, serum protein level rose up to 7.0 g/dl in a week. Specimen of the resected stomach consisted of a large cauliflower-like Borrmann 1 type cancer (14×8×4.5 cm), and histological diagnosis was that of well differentiated tubular adenocarcinoma.