広範なⅡa様進行癌とBorrmann Ⅱ型の多発胃癌例

Double Cancers of the Stomach (Ⅱa Type Advanced Cancer and Borrmann Ⅱ Type), a Case Report

　最近多発胃癌の症例報告が増加しつつあるが，われわれも特異な形をしたⅡa様進行癌とBorrmann Ⅱ型との多発進行胃癌を経験したので報告する．

　A 65-year-old man visited the authors' hospital complaining of pain and sensation of fullness in the epigastrium he had felt during the past one year.

　X-ray and endoscopy examinations of the stomach revealed two independent lesions: the one was a low and well-defined protruding lesion composed of various-sized nodules. It was located over both the anterior and posterior walls surrounding the gastric angle. The other was also a sharply circumscribed protrusion with an irregular-shaped ulcer in its center, located on the anterior wall of the pyloric antrum. Preoperative diagnoses of the two lesions were early cancer of Ⅱa type (lesion ①) and advanced carcinoma of Borrmann Ⅱ type (lesion ②), respectively.

　Histopathologically, the lesion ① was adenocarcinoma tubulare, most of its infiltration limited within the muscoal layer with partial involvement of the muscular coat. The lesion ② was adenocarcinoma tubulare mucocellulare intermixed with adenocarcinoma tubulare also with partial spread into the muscular coat. The two lesions were histologically located quite independently from each other. The lesion ① is sometimes mistaken for hypertrophic gastritis or for early cancer of Ⅱc＋Ⅱa type, so that we must be prudent in the diagnosis of such a lesion.