生検で癌陽性のⅡc型からBorrmann3型に推移し10年6か月にわたって画像的に経過追跡した1例

Borrmann 3 Type Advanced Gastric Cancer Followed Up for 10 Years and 6 Months from the First Histologically Confirmed Ⅱc Lesion, Report of a Case

要旨　患者は初回潰瘍の経過観察中，生検癌陽性のため手術を勧めたが拒否，全く消息を絶った．しかし10年6か月後手術を受けたことを偶然知り，術後遡及的に経過を探求した結果，その間2回上腹部検査を受けていたことが判明した．入手できた資料および手術材料の検討から，瘢痕を伴うⅡc型早期胃癌からBorrmann 3型胃癌に推移したと推測される1例であった．生検で癌陽性の瘢痕を伴うⅡc型早期癌から，抗癌剤などの治療をすることなくBorrmann 3型癌へ推移した症例で，10年以上にわたり画像的に経過を追及した例は極めてまれと思われるので報告した．

　A 61-year-old male patient was diagnosed as having Ⅱc type gastric cancer with ulcer scar on the posterior wall of the upper gastric body confirmed by biopsy at Edobashi Naika Center Clinic in Apr. 1979.

　The patient refused surgical treatment and nothing more was heard of him for many years.

　After about 10 years we accidentally heard that he had undergone surgery and retrospective study of the progress of his lesion was traced. He had not been administered any anticancerous agent until his operation.

　He received the examination of upper gastrointestinal series of x-ray and endoscopy in Shitaya Hospital in Jan. 1986. They reported the ulcerative lesion at the same position on the posterior wall of the upper gastric body. The endoscopic biopsy resulted in the positive identification of a poorly differentiated adenocarcinoma. Further in Nov. 1988 he received the next examination of upper gastrointestinal x-ray in the same hospital again. The x-ray showed a Ⅱc-like advanced cancer suspect, and by the following endoscopy the diagnosis of advanced cancer of Borrmann 3 type was made after biopsy of the poorly differentiated adenocarcinoma.

　In Oct. 1989 he was admitted as an emergency case to Tokyo Women's Medical College Hospital for hematemesis and melena. On Oct. 26 1989 total gastrectomy with resection of pancreas tail and spleen was carried out. The gross specimen showed Borrmann 3 type gastric cancer measuring 78×65 mm located on the posterior wall of the cardiac portion. Histologically poorly differentiated adenocarcinoma, serosa exposed, stage Ⅲ was able to be ascertained, but absolutely curative resection was done.

　As to the advancement of the cancer in this case, our reasoning from morphological aspects was as follows: The Ⅱc lesion with ulcer scar on the gastric body repeated its malignant cycle, and still remained within the category of early gastric cancer during the period of 6 years and 9 months since first detection. In the further 2 years and 10 months, i.e., until 9 years and 7 months from the beginning it became an advanced cancer. Borrmann 3 type cancer advancing from Ⅱc with ulcer scar as in this case followed up by long-term (over 10 years) observation is very rare.