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Stomach and Intestine(Tokyo) Volume 27, Issue 1 （January 1992）

胃と腸 27巻1号（1992年1月発行）

Japanese English

今月の主題胃癌の自然史を追う―経過追跡症例から

主題症例

胃角部前壁からの生検で癌が証明され，その6年2か月後にBorrmann2型癌として切除された1例 Borrmann 2 Type Gastric Carcinoma, Resected 6 Years and 2 Months after the Detection of Cancer Cells by Biopsy, Report of a Case 中野實 ¹ , 松崎修 ² , 藤本昌雄 ² , 松下智人 ³ , 大西武司 ⁴ Minoru Nakano ¹ , Osamu Matsusaki ² , Masao Fujimoto ² , Tomohito Matsushita ³ , Takeshi Ohnishi ⁴ ¹市立伊勢総合病院放射線科 ²市立伊勢総合病院内科 ³三重大学医学部放射線科 ⁴大西クリニック ¹Department of Radiology, Municipal Ise Sogo Hospital ²Department of Internal Medicine, Municipal Ise Sogo Hospital ³Department of Radiology, School of Medicine, Mie University ⁴Ohnishi Clinic キーワード：胃癌経過追跡例 , 胃分化型癌 Keyword: 胃癌経過追跡例 , 胃分化型癌 pp.77-82

発行日 1992年1月25日 Published Date 1992/1/25

DOI https://doi.org/10.11477/mf.1403106683

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要旨　患者は66歳，男性．約6年前胃集検で異常を指摘され来院．胃角部前壁からの生検で癌が得られ，再生検でも癌陽性となった．しかし内視鏡像からは癌巣を確認できず，5か月後も同様の所見で，この時の生検では癌陰性であった．手術を勧めたが無症状のため拒否，結局癌の形態や範囲も明らかにされないまま放置された．初診から6年2か月後，貧血と下血のため入院．体下部から前庭部の前壁に大きなBorrmann2型病変を認め切除，深達度se，UI(－)の分化型癌であった．本例は，結果的には癌の自然史を観察しえたことになるが，初診時の内視鏡像の見直しでも癌の実態を捉えることができず，その初期像はUI(－)，Ⅱb様の微小ないし小胃癌と推察された．

　The patient was a 66-year-old man. About 6 years ago, he visited our hospital for further examination because in a mass survey check up, abnormal findings had indicated that he may have gastric cancer.

　X-ray and endoscopic examination were carried out three times during the next 5 months. A biopsy specimen taken from the anterior wall of the gastric angle during the first endoscopic examination on Nov. 13, 1976 diagnosed him as Group V. Re-biopsy was carried out 11 days later, and well differentiated adenocarcinoma (Fig. 5) was diagnosed. However, endoscopic pictures could not reveal any cancerous lesion (Figs. 2a, 2b, 4a, 4b and 4e), and x-ray picture also depicted no evidence of gastric carcinoma (Figs. 1a, 1b). We recommended surgery, but he refused it because of having no complaints.

　Six years and two months after the initial examination of his stomach, he was admitted to our hospital because of severe anemia and tarry stool on Jan. 5, 1983. X-ray and endoscopic pictures revealed a large Borrmann 2 type gastric carcinoma on the anterior wall of the under part of the gastric body and antrum (Figs. 6, 7).

　Surgery was carried out on Jan. 14, 1983. The resected specimen of the stomach (Fig. 8) showed Borrmann 2 type advanced carcinoma. Histological diagnosis was well differentiated adenocarcinoma (Fig. 11). This coincided with the diagnosis from the biopsy specimen, and cancer cells had infiltrated the entire gastric walls (Figs. 9, 10).

　From the above findings, it was suspected that the primary focus of this case (about 6 years ago) was Ⅱb or Ⅱb-like cancer without ulcer, and having only minute or small cancer lesion.

　The patient is still alive 8 years and 11 months after the operation.