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早期胃癌研究のうちでも村上1)によって提唱された悪性サイクルの概念は最も重要なものの1つであるが,著者らは約2年3カ月にわたり経過観察を行ない,胃潰瘍様所見の再発を4回くり返し悪性サイクルをたどったと思われる1例を経験したので報告する.
症例
患 者:T. M. 34歳 女(主婦)
主 訴:心窩部痛
家族歴および既往歴:特記すべきことなし
現病歴:1972年6月中旬より心窩部痛あり某医に受診,約1週間にて軽快するも,7月上旬より再び心窩部痛を来たし,7月17日来院,レ線検査の結果胃潰瘍と診断され入院した.
A case of early gastric cancer is described which was considered to have followed a malignant cycle, ulcer recurring four times (Fig. 1). This case was followed up for as long as 2 years and 3 months, examined in between 13 times by x-ray and 14 times by endoscopy.
The patient, a 34-year-old woman, with a chief complaint of pain in the upper abdomen visited us for medical workup. The initial x-ray (Fig. 2) and endoscopy (Fig. 3) revealed an ulcer-like lesion, measuring 1.5×1.0 cm, on the lesser curvature above the angle. One month later scarring of the lesion was demonstrated (Fig. 4). Subsequently ulcer reurredc four times (Figs. 5~18). Biopsy was performed at the 13 th endoscopy(Fig. 19). A diagnosis of a Ⅱc lesion was followed by surgical intervention.
Retrospective study indicated that biopsy should have been done at the initial endoscopy (Fig. 3) with a suspicion of malignancy, because there had been a shallow depression around the ulcer-like lesion along with club-like swelling and interruption of the mucosal folds coming from the posterior wall. Furthermore, a diagnosis of Ⅱc ought to have been made during the scarring stage in the course of follow-up because shallow depression and tapering of the mucosal folds were revealed by x-ray and distinct fading of the mucosal color was seen by endoscopy.
Gross specimen of the resected stomach (Figs. 21, 22, 23) showed a shallow depression at the angle, measuring 3.0×3.0 cm. We were also able to trace a Ⅱc lesion, although it was not so clear-cut. Histologically it was adenocarcinoma mucocellulare. The degree of infiltration was m, Almost in the center of the lesion was seen an ulcer scar, Ul-Ⅲ, in which no cancer cells were demonstrated. There was no lymphnode metastasis.
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