malignant cycle症例

malignant cycle

　患　者：T. M.　61歳　男性

　68年10月，心窩部痛とくに空腹時痛を主訴としてわれわれの病院をおとずれ，広範なビラン性胃炎がみとめられたため，この治療をうけていた．

　Case: T. M. 61 years old male.

　In October 1968 the patient had visited our hospital complaining of pain in the epigastrium, especially when hungry. Because of extensive gastritis erosiva detected then he had been under our medical management.

　During the 21 months from the initial examination to July 16, 1970, when finally he underwent gastric resection, he had been x-rayed 9 times with endoscopy, 8. In the interim, it was judged once by x-ray and once by endoscopy that a malignant lesion must also be taken into account, but diagnosis was not confirmed.

　In the beginning of April 1970 he had increasing pain in the epigastrium, so that he was admitted to the hospital under a diagnosis of gastric ulcer, for which medical management was given. After one month of treatment ulcer disappeared (Figs. 6, 7), but a depression accompanied with mucosal elevations of irregular size remaining in the wake of ulcer was suggestive of a malignant change. Later on the depression was diagnosed as cancer by FGS-biopsy. A Ⅱc type cancer was also revealed by x-ray pictures taken thereafter (Figs. 8, 9). The localization and shape of cancer nests clearly show that ulcer within them came and went twice.

　Retrospective studies of data obtained in this case have demonstrated that cancer lesion was well visualized already in the first examination. The first cycle in the repeating wax and wane of ulcer within cancer nests is shown in Figs. 1 and 2. Recurrence of ulcer gave us a clue to the detection of cancer.

　Results of laboratory examinations: ―

　　red blood cell count, 4,710,000

　　white blood cell count, 5,300

　　hemoglobin 14.8 mg/dl

　　total protein, 7.5 mg/dl

　　A/G ratio, 1.0

　gastric acid (stimulated by histimin):

　　14.9 mEq/h―19/7/69

　　15.7 mEq/h―22/5/70

　occult blood in the stool (benzidine)

　　(＋)―14/ V /70

　　(±)―18 V /70

　　(＋)―23 V 70