いわゆる“胃潰瘍癌”に関する臨床病理学的検討

Clinico-pathological Studies on So-called Ulcer-cancer of the Stomach

　Hauser（1926）¹⁾，Newcomb（1932）²⁾らによって胃潰瘍癌の病理組織学的判定基準が発表された．しかしStromyer（1912）³⁾らはこれに反論し，Mallory（1940）⁴⁾，Palmer ＆ Humphrey⁵⁾らは癌巣中の二次的な消化性潰瘍が縮小することを示してHauserらの基準が消化性潰瘍先行を証拠立てるものではないとした．

　わが国においても，その論争のレベルこそちがえ1950年代の後半から1968年にかけ，殊に早期癌を中心に潰瘍癌をめぐる論議は活発に行なわれたが，いずれとも結着がつかないまま今日に至っている．

　A total of 132 stomachs with gastric cancers of depressed type resected surgically, were subjected to the study. The 132 cases had been clinically eximined by x-ray and/or endoscopy 2 weeks to 10 years prior to the operation. Retrospective analyses of their clinical course and histopathological findings of the resected stomachs have given us the following results.

　1) No case was observed who had primary gastric ulcer to make cancerous change.

　2) The great majority of the resected stomachs satisfying the histopathological criteria for ulcer-cancer had clinically been observed as complete or incomplete healing of peptic ulceration in the cancerous area.

　3) The commonest pathological future of ulcer-healing-cancer was cancer-cell-free dense submucosal fibrosis at and far from the advancing margin of the canter.

　4) Growing rate of gastric cancer with cancer-cell-free fibrosis was slower than that of gastric cancer without such fibrosis.

　The above-mentioned findings have led us to consider that the so-called ulcer-cancers are merely carcinomas associated with chronic peptic ulceration.

　It should also be emphasized that rate of growth gastric cancer may greatly be influenced by peptic invasion in the cancerous tissue.