胃変形の少ない時期に診断されたLinitis plastica状態の癌の1症例

Carcinoma of Linitis Plastica Type Diagnosed in Relatively Early Phase, Report of a Case

　数年にわたる胃X線検査で異常なく経過していて，突然X線像上にleather bottleの像が現われ，臨床医の心胆を寒からしめるものがある．しかも，Linitis plastica状態の胃癌の予後は極めて不良である．このような状態になる以前に診断しなくてはならないが，一般的には，診断はなかなか困難な場合が多い．われわれは，原発巣が比較的小さいにもかかわらず，癌細胞が粘膜以外の胃壁にび玄ん性に広範囲な拡がりを小した，胃壁の伸展不良の程度が軽度である，いわゆるLinitis plastica状態の拡がりを示す癌を経験したので報告する．

　A 39 year-old female was admitted to our hospital with chief complaints of hematemesis and melena. She had suffered from epigastralgia before meal in the morning since about 7 years before. About 1 year ago, an x-ray examination of the upper GI-tract was carried out in mass survey, but abnormal ings were not disclosed.

　In our hospital, detailed examinations of the upper GI-tract by means of and endoscopy revealed a small ulcerative lesion and a few tortuous hypertrophied rugae of the mucosa in the posterior wall of the corpus. There was no contraction of the stomach anywhere. She was diagnosed as having carcinoma of Borrmann 4 type, and total gastrectomy was performed.

　The resected stomach macroscopically showed an ulcerative lesion measuring about 1.5cm in the largest diameter in the posterior wall of the corpus. There were hypertrophic and tortuous rugae of the mucosa in the corpus.

　The ulcerative lesion histologically showed carcinoma with a shallow ulcer of depth Ul-Ⅱ, the intramucosal portion of which was adenocarcinoma mucocellulare, and located in the fundic gland mucosa area without intestinal metaplasia. In the gastric layers except the mucosa, cancer cells diffusely infiltrated to the oral two-third of the resected stomach in which there was proliferation of fibrous connective tissue (scirrhous carcinoma).

　This case clinically did not show “leather bottle stomach” However, histopathological examination revealed an extent of carcinoma of linitis plastica type.

　It may be important to clinically disclose small ulceration of the corpus for diagnosis of linitis plastica in early stage.