2年3ヵ月間経過観察し悪性サイクルをたどったと思われる胃粘膜内癌の1例

A Case of Intramucosal Cancer of the Stomach followed up for 2 Years and 3 Months considered to have followed the Malignant Cycle

　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.