malignant cycle症例

malignant cycle

症　例：K. T.　49歳　♀

現病歴：昭和44年1月の成人病健診で，胃体下部小彎側に潰瘍を指摘され，その後は良性潰瘍として内視鏡検査で経過を追うことになったが，同年11月の内視鏡像（3回目）で悪性が疑われ，当院にて胃生検の結果Group Ⅴと診断され入院した．入院時の胃液検査（ヒスタローグ法）は過酸であった．

　Case: K. T., 49-year-old female.

　Present illness: At an adult health examination in January, 1969, an ulcer had been detected in the lesser curvature side of the lower. Since then she had been followed up by endoscopy as benign ulcer. In November of the same year malignancy was suspected by the third endoscopy examination. Soon she was admitted to the hospital because biopsy confirmed a diagnosis of Group Ⅴ. Gastric juice at admission showed hyperchlorhydria after histalog stimulation.

　Summary of endoscopic pictures

　The first picture (4-26-69)―Fig. 1

　A fairly well-defined rounded ulcer was seen in the lesser curvature side of the lower body. A slight protrusion was also observed on its margins on the anterior wall. Diagnsed as benign ulcer.

　The second picture (7-12-69)―Fig. 2

　The ulcer first seen was smaller and cicatricized. Engorgement was also seen in the center of mucosal convergence.

　The third picture (11-29-69)―Fig. 3

　A shallow depression was seen in the former site of the scar observed in Fig. 2. Mucosal folds converging from the anterior wall toward it were thinner and smaller around the ulcer margins. This time malignancy was strongly suspected. Gastric biopsy on 12-10-69 proved positive for cancer.

　The fourth picture (1-12-70)―Fig. 4

　Mucosal convergency was seen in the lesser curvature side of the lower body associated with central bleeding spots. Ⅱc-like findings were not distinct.

　Date of operation: 1-28-70.

　Histological findings of the excised stomach: ―

　The site of lesion: in the lesser curvature side of the lower body.

　Size: 14×20 mm.

　Histological diagnosis: adenocarcinoma tubulare mucocellulare (Ul-Ⅲ) with depth of invasion m.

　Classification: Ⅱc＋(Ⅲ).

Conclusion

　Retrospective study of this case through endoscopic pictures has shown us that two of the most noteworthy findings in the initial picture were marginal irregularity on the anterior side of the ulcer and protrusion in the pyloric side. Malignancy could have been suspected because of irregular, discolored area around the engorged mucosa. A malignant cycle in early gastric cancer is exemplified in size and scarring of ulcer were seen in the course of nine months.