Ⅱc型早期胃癌と胃腺腫を合併した原発性アミロイドーシスの1例

Primary Amyloidosis Associated with IIc Type Early Gastric Cancer and Gastric Adenomas, Report of a Case

要旨　患者は68歳，男性．胃検診目的で近医を受診しⅡc型早期胃癌と診断され，術前検査のため1982年8月31日当院入院．胃X線および内視鏡検査では胃体部に2個の不整形の陥凹と多発するびらんが認められた．不整形の陥凹は双方とも肉眼的にはⅡc型早期胃癌が疑われたが，生検では一方より癌，他方よりアミロイドの沈着が認められた．アミロイドーシスの原因となる基礎疾患は認められず，原発性アミロイドーシスと診断された．切除標本の検索では，胃癌のほかに3個の腺腫を認めたが，これらの病変とアミロイドーシスの合併は偶然と考えられた．アミロイドの沈着によって生じる不整形の陥凹とⅡc型早期癌との鑑別は肉眼所見のみでは困難な場合があり，生検による確診が必要と思われた．

　A 68-year-old man without subjective symptom was diagnosed as having Ⅱc type early gastric cancer by upper gastrointestinal x-ray examination and subsequently performed endoscopy. He was admitted to our hospital on August 31, 1982 for preoperative examination. Laboratory findings on admission were normal except for atrial fibrillation on electrocardiogram. Bence Jones protein was not detectable in urine. Upper gastrointestinal series revealed an irregularly-shaped depressed lesion and several barium flecks in the gastric body. Endoscopy of the stomach demonstrated multiple erosions in the upper body and two irregular reddish depressed lesions in the middle and lower body, the latter of which was suggestive of Ⅱc type early gastric cancer. Histologic examination of the biopsy specimens from one depressed lesion revealed well differentiated adenocarcinoma, while those from the other lesion and multiple erosions revealed amyloid deposition. He had no underlying diseases which could be responsible for amyloidosis and was diagnosed as having primary amyloidosis. Partial gastrectomy was performed. Pathologic examination of the resected specimen showed Ⅱc type early gastric cancer, gastric adenomas, and multiple erosions caused by amyloid deposition. Gastric cancer and adenomas did not seem directly related to amyloidosis. Endoscopic biopsy was useful to differentiate between the irregularly-shaped depressed lesion caused by amyloid deposition and Ⅱc type early gastric cancer.