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われわれは最近74歳男子の胃多発病変(1個の進行癌と3個の異型上皮病変)の1例を経験したので報告する.
症例
患 者:N. T.,74歳,男
主 訴:とくになし.
家族歴:母が癌死?
既往歴:17歳のとき腸チフス,40歳のとき肺炎,6年前から高血圧に罹患.
現病歴:上記のごとく高血圧症にて本院内科に通院加療中,健康診断の意味で当科にて胃レ線検査をうけたところ以下にのべるような病変を指摘され手術の目的で入院した.食欲は良好で体重減少もなく便通は1日1行,規則的であった.
現 症:体格中等度,栄養状態まず良好.眼瞼結膜に貧血なく眼球結膜に黄疸なし.舌苔なし.脈拍整で緊張良好,Virchow氏リンパ節を触れず,また胸,腹部にとくに異常を認めない.
Case: A 74-year-old male.
X-ray revealed three independent lesions. The first was an irregularly-outlined nodular protrusion with slightly depressed surface located on the lesser curvature just above the gastric angle; the second was composed of granular mucosal changes uneven in size and shape, situated at the antrum just anal side from the gastric angle ; the third, a small polypoid lesion on the mid portion of the corpus.
Endoscopy also revealed three independent lesions. The first was a nodular protrusion with depressed surface irregular in shape and uneven in base on the lesser curvature above the angle : the second was a plateau-like lesion with granular surface on the posterior wall of the antrum ; and the third, a small hemispherical lesion on the anterior wall in the midportion of the corpus.
The gross specimen of the resected stomach are summarized as follows.
1. An irregularly-outlined slightly elevated lesion, 2.5×1.4 cm in size, with partly eroded surface on the lesser curvature of the junctional zone.
2. A plateau-like lesion with granular surface, 2.5×4.5 cm in size, in the posterior wall of the antrum and junctional area.
3. A pedunculated polyp, measuring 1.0×0.7 cm with lobulated surface originating in the anterior wall of the body.
4. Two adjacent depressed lesions, each 1.0×1.0 cm in size, partly accompanied by low protrusions with gyrus-like surface on the lesser curvature of the antrum. This lesion could not be pointed out preoperatively.
Histologically, the lesion 1 was signet-ring cell carcinoma partly invading the muscularis propria. The lesion 2 was an adenoma of severe atypical epithelium with some suspicion of well-differentiated adenocarcinoma. The lesion 3 was an adenomatous polyp with slight atypicality and the lesion 4 was adenoma with moderate atypicality.
In aged persons, coexistence of multiple lesions of the stomach is common; therefore, it is of great importance to check up on the entire stomach in diagnostic process.
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