4年7か月の経過の後linitis plastica型に発展したⅡc型早期胃癌の1例

Prospectively Observed Cancer Development from Type Ⅱc to Linitis Plastica during 4 Year 7 Months, Report of a Case

要旨　患者は52歳の女性．1985年9月，47歳時に胃集団検診で異常を指摘され，当院を受診．精査の結果，体下部後壁のⅡc型早期胃癌と診断した．患者は癌の告知にもかかわらず手術を強く拒否した．その後，経時的に経過観察を施行．Ⅱc類似進行病変を経て，限局性の壁硬化が始まるまでに比較的緩徐に経過し，以後急速にlinitis plastica型胃癌へと進行した．上腹部痛および食欲不振を来し，患者は手術を希望．1990年5月11日，胃全摘および膵，脾合併切除術を施行した．本症例はretrospectiveな考察と異なり，初回検査時に胃癌の確診を得，linitis plastica型胃癌までの発育過程を経時的に捉えた点で興味あるものと考える．

　The case is that of a 52-year-old woman who had an abnormality pointed out by gastric mass survey in September 1985 (age 47) and then came to our hospital. Gastrography and endoscopic biopsy led to the diagnosis of Ⅱc early gastric cancer in the posterior wall of the lower corpus. The patient, who was subjectively asymptomatic strongly refused the surgery despite notice of cancer. Subsequent periodic observations of the course were made. Comparatively slow progress from Ⅱc-like advanced cancer to localized wall sclerosis took place and subsequent quick progress to linitis plastica occurred. At the request of the patient who was then complaining of epigastralgia and anorexia, total gastrectomy and splenopancreatectomy were carried out on May 11, 1990.

　In contrast to retrospective cases, we regarded this case as rather interesting in that the first examination led to a positive diagnosis as gastric cancer, and its process of development up to linitis plastica could be gradually observed. We would like to report this case with a brief comment.