Ⅱc＋Ⅱb型早期胃癌に合併し，Ⅱa様隆起を呈した隆起型胃潰瘍瘢痕の症例

Elevated Type Gastric Ulcer Scar, Report of a Case

　幽門前庭部に発生する対称性潰瘍は，臨床症状，形態などが異なり，またX線および内視鏡検査のうえで特異な形態をとる場合があり，悪性病変との鑑別が困難な場合がある．幽門前庭部に発生した潰瘍が，その治癒過程において，隆起を示す場合があることは蔵原ら¹⁾によって呈示されている．また高木²⁾，中野ら³⁾は，前庭部急性対称性潰瘍の治癒期において，ⅡaおよびⅡa＋Ⅱc型早期胃癌と紛らわしい形態をとる可能性があることを指摘している．しかしながら，潰瘍の治癒過程において隆起を示す場合も，いずれも比較的短期間で治癒平坦化しており，2カ月以上の経過観察においても，なおⅡa様隆起を示し，Ⅱa様早期胃癌と鑑別が困難であった症例は極めて少ない．

　今回われわれは，胃角上部小彎にⅡc＋Ⅱb型早期胃癌を合併し，胃角後壁に6カ月間経過観察された，Ⅱa様隆起を示す非対称性潰瘍瘢痕と考えられる症例について経験したので報告する．

　Radiological and endoscopical examinations demonstrated two lesions. One was a Ⅱc+Ⅱb type early gastric carcinoma on the lesser curvature above the gastric angle, and the other lesion was an elevated type of ulcer scar. The latter lesion was observed endoscopically with biopsies for six months, and biopsy was performed three times, but any biopsy specimens taken from the latter did not show any malignant findings until the last biopsy specimens taken from the former lesion showed malignancy, so we decided on a course of operation.

　There are some reports that acute symmetric gastric ulcer of the antrum may show an elevation, but it is rare that a single ulcer shows elevation for more than two months. Some reporters say that the elevated type of gastric ulcer scar is usually located in the antrum and the depth of ulcer is Ul-Ⅱ.

　The elevation of our case is composed of hyperplastic changes of the pseudopyloric gland and foveolar epithelium, and elevated muscularis mucosa with fibrosis. It is interesting that the hyper-regenerative process after mucosal defect may show the elevation. It is important to distinguish this lesion from other lesions such as elevated type early carcinoma, and atypical epithelium, but if we check the following points, we may be able to distinguish this lesion from others.

　The one point is convergence of the mucosal folds to the elevated lesion, and the other is granulation and redness pattern on the surface of an elevated lesion.