短期間に著明な変化を示した早期胃細網肉腫の1例

Early Reticulum Cell Sarcoma of the Stomach: Report of a case showing remarkable changes within a short time

　われわれは，比較的短期間の間に，きわめて著明な変化をした早期胃細網肉腫の症例を経験したので報告する．

症例

　患　者：T. N.　42歳，男，会社員．

　既往歴：22歳のときに肺結核に罹患し，3年間治療した．

　嗜　好：27歳のときより毎日酒1合，煙草20本．

　現病歴：昭和45年夏頃より，腹部膨満感および停滞感があった．

　Case: T. N., a 42-year-old male. After two months' treatment at his neighboring doctor, the patient was referred to our hospital with a suspicion of gastric cancer.

　First x-ray examination at the outpatient clinic revealed marked shadow defect on the lesser curvature of the stomach from the lower part of the body to the antrum. Subsequent endoscopic study disclosed a large auricle-shaped tumor with irregular surface and deep ulceration, protruding in the corresponding area over the angulus. At admission, no abnormal findings were detected by both physical and laboratory examinations except slight tenderness in the epigastrium.

　At the second x-ray examination on admission, forty days after the first one, the shadow defect in the lesser curvature over the angulus seemed to have diminished markedly. Endoscopy also revealed disappearance of the tumor there. No malignant cells were demonstrated by the biopsy study performed then. The third x-ray study 20 days later showed that a thumb-tip-sized tumor with a well-defined border reappeared in the lower part of the body on the anterior wall, which was corroborated by endoscopy as well. Astonishingly the tumor had ulcerated and diminished both in height and size when examined by x-ray and endoscopy performed one week later. By that time the lesions were proved by the second biopsy as belonging to reticulum cell sarcoma. At the fourth x-ray and endoscopic examinations diffuse protrusion was seen to have appeared at the angulus on the posterior wall. Fifth examinations done two weeks later clearly revealed in the double contrast pictures a small ulcer with slightly raised margins together with rugal convergency in the lower body on the anterior wall, where a round tumor had been located at the third examination. Ulcer scars were also presumed to be at the antral side. Diffuse protrusion became more distinct by that time. In the sixth x-ray and endoscopic examinations one week later the lesions seemed almost the same as in the previous examination.

　Gastric resection was performed. In the resected specimen discoloration was observed around the angulus, encircled by three round tumors, one on the anterior, and two on the posterior wall. Converging mucosal folds surrounded the tumors and disclolored mucosa. Histologically, infiltration of sarcoma cells in the tumor were limited to the submucosa, and regional lymph nodes were free from malignancy.

　Although there have been several reports on early reticulum cell sarcoma with marked changes evolving in a relatively short time, our present case seems to be the most remarkable one, suggesting the existence of “malignant cycle” as in early gastric cancer.