著明な蛋白漏出と絨毛状発育を呈したⅠ＋Ⅱc型早期胃癌例

A Case of Villous Appearing Ⅰ＋Ⅱc Type Early Gastric Cancer with Remarkable Protein Loss

　広範な絨毛状発育を呈したⅠ＋Ⅱc型早期胃癌で，種々のラジオアイソトープ検査により蛋白漏出部位を確認しえた興味ある症例を経験したので報告する．

　症　例

　患　者：石○よ○ゑ　50歳　女性

　主　訴：顔面および四肢の浮腫．上腹部痛．

　家族歴：特記すべきことなし

　現病歴：1975年1月頃より顔面および四肢の浮腫に気づいたが放置していた．1976年6月に近医を訪ずれ，貧血と動脈硬化症の診断で治療をうけたが，症状は改善せず，しかもその後，上腹部に軽度の空腹時痛を訴えるようになった．同年11月に当センター検診科の胃集団検診をうけ，胃に巨大な隆起性病変の存在を指摘され，12月に同科で胃内視鏡検査および胃X線検査をうけ，進行癌と診断されて，1977年1月に手術の目的で入院した．

　This case is a 50-year-old woman with epigastric pain, edema on the face and extremities. Laboratory examinations on admission showed 2.8 g/dl～4.0 g/dl serum protein and 8.1% increased ¹³¹I-PVP excretion rate. X-ray and endoscopic examinations of the stomach revealed large villous appearing tumors from the angle to the pyloric antrum, which were suspected as advanced cancer. Since gastric biopsy indicated poorly differentiated adenocarcinoma, gastrectomy was done on Feb 23, 1977. Specimen of the resected stomach consisted of two large cauliflower-like soft tumors, measuring about 7 X 7 cm and 6 X 6 cm in diameters respectively, located over the posterior wall of the angle to the pyloric antrum. Histopathological diagnosis was Ⅰ＋Ⅱc type early signet ring cell carcinoma and its infiltration was limited within sm layer.

　Gastric biopsy was done after ¹³¹I-PVP intravenous injection and then isotope counts were measured on the tissue of almost normal mucosa and that of tumors, to determine the protein losing area in the stomach. Isotope counts of the tissue from the villous appearing tumors were higher than those from the others. Computed analysis obtained from the resected stomach scanning by Gamma-Camera indicated higher isotope counts on the tumors areas than on the others. Diagnosis of the protein losing area made before operation agreed well with the result of resected stomach scanning. And then, we came to the conclusion that the hypoproteinemia of this patient was induced by protein loss from the surface of the villous appearing tumors in the stomach.