メネトリエ病に合併した早期胃癌の1例

A Case of Early Gastric Cancer Associated with Ménétrier's Disease

　Ménétrier病の問題点の1つとして，本症の癌化の問題は古くから論じられてきた．本症の2.7～8％に胃癌の合併が報告されている．しかしこれら症例の大多数は進行癌との合併例であり，これらの胃癌が明らかにMénétrier病を基盤として発生したものであって，胃癌の結果巨大すう襞が生じたのではないと断定することはしばしば困難である．本症の癌化を論ずる場合，本症と初期胃癌の合併例の検討はきわめて重要と考えられるが，文献的にそのような合併例はきわめてまれである．

　著者らは最近本症と早期胃癌の合併例を経験したので報告する．

　Case: a 50-years-old male. The patient visited our clinic because of dull pain in the stomach when it was empty and nausea he had felt since six months before. No loss of weight. No abnormality was seen in the physical examination. Laboratory examinations were normal except for low serum protein level (5.5 g/dl). Gastric juice was of normal acidity.

　X-ray findings: The mucosal relief from the corpus to the angle was very much broadened and twisted.

　Endoscopic findings: No malignant picture was seen on the giant rugae from the corpus to the angle, but a fairly large Ⅱc lesion was found between the angle and the lesser curvature of the antrum.

　Biopsy was positive for cancer. Diagnosis: gastric cancer. However, it was not clarified whether there was any cancer invasion into the submucosa of the enlarged folds.

　Gross findings of the removed stomach: The gastric corpus as a whole was a mass of markedly broadened mucosal folds. They were meandering and convolutional. The mucosal folds on the anterior wall measured 1.5～2.0 cm both in height and breadth. Below these broadened folds was seen a Ⅱc lesion, measuring 6.0×5.0 cm, on the lesser curvature of the antrum.

　Histological findings: Adenocarcinoma tubulare intermixed with carcinoma mucocellulare was seen in a site almost corresponding to the area of cancer macroscopically diagnosed as such. Its depth invasion was chifly m with partial sm involvement. The broadened mucosal fold were due to (1) epithelial hyperplasia of the gastric pits, (2) hyperplasia of pseudopyloric glands, (3) marked cystic formation in the deeper part of the mucosa as well as in the submucosa and (4) distortion and fibrosity of the lamina propria together with round cell infiltration. Of these, the first and the third were most responsible for giant folds. Most of these folds were free from cancer except a small area adjoining the Ⅱc, where cancer was recognized in the mucosa.

　Association of Ménétrier's disease with early gastric cancer is of such a rare occurrence that only three cases have been reported so far. Although causal relation between the two is as yet unknown, clinically it is to be remembered that gastric cancer can at times be associated with benign giant mucosal folds.