いわゆる梅毒性胃炎と早期胃癌の併存した1例

Syphilitic Gastritis Concurrently Existing with Early Gastric Cancer, Report of a Case

要旨　患者は48歳，男性．1983年6月ごろより，左前胸部痛，心窩部不快感あり．このころ，左前胸部から腹部にかけて発疹が出現したが約1週間で消失した．更に時々嘔気あり当科受診．胃X線，内視鏡検査で幽門前庭部に全周性に浅い陥凹病変と，その中に結節状の残存粘膜島が存在していた．体下部前壁側に皺襞集中を有する陥凹病変を認めた．血清梅毒反応はガラス板法32倍以上，緒方法640倍以上，TPHA法2,560倍以上であった．体下部前壁側の病変はⅡc型早期胃癌と診断，幽門前庭部の病変は梅毒性胃炎を疑いAMPC1,000mg/日，28日間投与の駆梅療法を行ったが所見の改善を得られず，早期胃癌併存のため胃切除術を施行した．切除胃の組織学的所見は幽門前庭部から胃角にかけて粘膜層～粘膜下層に著明な形質細胞を主体とした炎症性細胞浸潤を，一部では血管周囲炎を認めた．特異性肉芽腫は存在しなかったが，総合的に第2期梅毒の胃病変が強く示唆された．早期胃癌はⅡc，印環細胞癌，深達度m，INF-α，v₀，ly₀で大きさ15×10mmであった．

　A 48-year-old man visited our hospital because of nausea and skin eruption, which disappeared in a week, on the chest and abdomen. He had also been experiencing a left chest pain and epigastric discomfort since June 1983.

　Radiographic and endoscopic examinations of the stomach revealed shallow depressions with a nodular, residual mucosal island in the center of the prepyloric region. There also was a concave lesion with wrinkled nest on the anterior wall of the lower body. The serologic tests for syphilis were positive at titres of 1 : 32 in microscopic slide precipitation test, of more than 1 : 640 in Ogata agglutination reaction and of more than 1 : 2560 in TPHA. The lesion on the anterior wall of the lower body was diagnosed as early gastric cancer of type Ⅱc, while the one in the antrum was considered syphilitic gastritis. Although antiluetic therapy was undertaken with AMPC 1000 mg/day for 28 days, no favourable results ensued. For the early gastric cancer, gastrectomy was carried out. Histological examination of the resected stomach showed inflammatory cellular infiltrates with inflammation of some peripheral veins in the mucosal and submucosal layers in the prepyloric region up to the gastric angle. Non-specific granuloma, however, was not noted, although general findings of the lesion strongly suggested secondary syphilis. It was confirmed that the early gastric cancer was type Ⅱc signet-ring cell carcinoma with a depth of m, INFα, v₀, ly₀ measuring 15×10 mm.