Ⅱc様所見を呈した比較的広い良性胃ビラン（良性Ul-Ⅱ瘢痕を伴う）の1例

The Widespread Gastric Erosion like Ⅱc Type (of Early Gastric Cancer) Accompanied with the Scar of Benign Gastric Ulcer (Ul-Ⅱ): Report of a case

　関節リウマチでステロイド治療中の患者に，Ⅱcまたはリンパ腫と紛らわしい像を呈した良性潰瘍瘢痕を伴う比較的広い良性胃ビランの1例を経験したので報告する．

　症　例

　患　者：61歳　女性

　主　訴：心窩部不快感

　家族歴：姉1人が胃癌で死亡

　既往歴：15歳慢性関節リウマチ，47歳胆石手術

　現病歴：慢性関節リウマチのため他院で長期間ステロでド剤の投与をうけていたが詳細は不明，同治療は当院受診直前まで継続．1976年4月6日当院整形外科受診，関節リウマチと診断，関節腔内ヘリンデロン2mgを2回注入．初診より入院まで約4カ月間にリンデロン95mgの経口投与をうけ通院．

　同年6月下旬より心窩部不快感または腹部膨満感と口渇を訴え，7月7日当院内科へ紹介．7月9日上部消化管X線検査．7月17日胃内視鏡検査，幽門部病変を指摘され．手術のため8月2日入院．

　A 61-year-old woman, who had been treated by steroid for rheumatoid arthritis for a long time, com plained of epigastric discomfort. The X-ray examination of the stomach revealed a shallow depressive lesion of uneven edge with converging folds and marginal elevation on the anterior wall near the lesser curvature at the prepyloric region. The gastroscopic examination demonstrated also the depressive lesion with marginal elevation. Numerous bleeding spots and islet-like prominences were observed on the surface of the lesion. The biopsy specimens were not malignant. The gastroscopic impression was Ⅱc type of early career or malignant lymphoma. Partial gastrectomy was then performed.

　Gross inspection of the resected stomach showed a depressive lesion, 20 X 25 mm, like Ⅱc type of early cancer on the anterior wall near the lesser curvature at the prepyloric region. The surface of the lesion was smooth and one of the converging folds was abnormally widened, but not slender.

　The histopathological findings revealed healed ulcer (Ul-Ⅱ stage) accompanied with interruption of muscularis mucosae. The pathogenesis of this case was presumed to be the long term steroid administration, but this erosion was not a typical steroid induced ulcer. If the gastric erosion like this case had been observed endoscopically for the period from genesis to healing, it might have been diagnosed as Ⅱc type of early cancer or a single widespread benign erosion. Careful follow-up study and repeated endoscopic biopsies are extremely important for these gastric lesions. Especially we would like to emphasize the importance of the above mentioned follow-up study and examinations. We have to concentrate our efforts on them in order to arrive at a diagnosis correctly.