原発巣が微小であったlinitis plastica型胃癌の1例

Typical Linitis Plastica Type Carcinoma of the Stomach, Report of a Case

要旨　患者は60歳男性で，上腹部もたれ感を主訴として人院した．切除胃は全割による病理組織学的検索がなされた．癌組織型は未分化型癌であり，癌が粘膜面に露出していたのは胃体部前壁の小陥凹面と胃角部小彎のびらん面であった．原発巣と考えられた小陥凹は，最大径5mmでUl-Ⅱの浅い潰瘍を伴い，組織学的に腸上皮化生のない胃底腺粘膜領域に存在していた．前庭部小彎のびらん周囲の粘膜は，腸上皮化生を伴った萎縮性幽門腺粘膜であり，病理組織学的および臨床的に粘膜下層内の癌細胞が逆行性に粘膜内へ進展したものと考えられた．粘膜下組織以深の癌浸潤範囲は20×17cmに及び，原発巣が微小であったいわゆるlinitis plastica型胃癌であった．

　A 60-year-old male was admitted to the hospital of Tsukuba University because of epigastric fullness and discomfort of two months' duration. Radiological figures were compatible with so-called leather bottle and endoscopical examinations revealed extremely decreased distensibility of the stomach. Total gastrectomy was performed.

　There were a minute depressed area with the longest diameter 5 mm in the anterior wall of the body and an erosive area measuring approximately 4.0×1.7 cm at the lesser curvature of the angle. The gastric wall was markedly thick with desmoplasia of adenocarcinoma.

　Histological examination of the minute depressed area showed mucocellular adenocarcinoma with a shallow ulceration (Ul-Ⅱ). This lesion was entirely surrounded with the fundic gland mucosa without intestinal metaplasia. There was a diffuse invasion of carcinoma cells involving most parts of the stomach measuring about 20×17 cm in dimension. The erosive area was a result of intramucosal spreading from the submucosal infiltration.