胃ポリープとして4年間経過観察を行なっていた小隆起性進行胃癌

A Protruding Type of Advanced Carcinoma of the Stomach Followed up as a Polyp for Four Years, Report of a Case

　術前の胃癌の経過が注目されるようになり，retrospectiveにみた胃癌の長期観察例が数多く報告されるようになったが，中でも表面陥凹型早期胃癌のそれが多く，隆起性胃癌の長期観察例は少ないようである．

　われわれは，当初，胃X線検査で胃ポリープと診断し，その後4年間，胃X線検査で定期的に経過観察を行なっていた胃の隆起性病変が，ある時期に著しい形態の変化を示したので，手術したところ，隆起性の腺癌で，すでに漿膜下層まで浸潤していた例を経験した．本例では，残念ながら胃内視鏡検査と生検による経過観察が行なわれていないが，X線写真上興味ある経過を示しており，胃癌の発育の一面を考える上で興味ある症例と思われたので，その経過の概要を報告し，諸家の御批判をあおぎたい．

　A case is reported of a small protruding lesion of the stomach, followed up by x-ray for four years up to the time of surgical intervention, when the tumor was confirmed as an advanced cancer. Changes observed by x-ray all through the time of follow-up have also been compared with histological changes of the resected specimen.

　The patient, a 36-years-old woman, had been followed up by x-ray since October 1964 for a pedunculated polyp, then considered benign, located on the lesser curvature of the body. In March 1967 (one year and a half before the operation), the tip of the polyp was noticed to have shrunk with pedicle hypertrophied and stiffened. An area suggesting a low elevation was also seen on the mucosa around the stalk. Retrospectively studied, it might have been cancer already then, but at that time we considered it benign. In August 1968 (four years after the time of initial x-ray) we noticed a well-circumscribed, broad-based protrusion at the site of the pedunculated polyp. Type Ⅰ early cancer was suspected then, and in the following month gastrectomy (R₂) was performed. The resected specimen revealed on the lesser curvature of the corpus a broad-based protrusion, 3.0 by 2.5 by 1.5 cm, which was histologically papillary adenocarcinoma, its vertical growth reaching the subserosal layer.

　Cancer nests did not show any finding to warrant a diagnosis of adenomatous polyp, nor was there any around them even to entertain such a suspicion.

　One month after the surgical operation she again underwent laparotomy because of ileus developed in the interim. Metastases were found in both lobes of the liver and the patient died six months later.

　Study of the preoperative x-ray films along with the histological findings of the excised specimen seems to show that it could have been at first a benign polyp, cancer originating later either at the base of or around the stalk. Cancer infiltration could have destroyed the stalk, causing the tip of the stalk to fall off. The normal architecture of the stalk must also have been destroyed by malignant invasion.