malignant cycle症例

malignant cycle

患　者：片○梨○　43歳　女性

既往歴：特記事項なし．

現病歴：昭和40年4月，41年9月及び43年9月に心窩部痛を訴え，胃潰瘍としてそのつど医師による治療をうけ軽快した．当科には精密検査の目的で43年11月にはじめて受診した．

　Patient: R. K., 43-year-old female.

　Past history: noncontributory.

　Present history: In April 1965, Sept. 1966 and again in Sept. 1967 the patient had bouts of pain in the epigastrium, for which he was treated every time as gastric ulcer with subsequent decrease of pain. In Nov. 1968 she visited our Department for a thorough check-up.

　Gastric juice: hypoacidity after histimine stimulation (1 mg/kg).

　General examinations: Within normal limits.

　Course of present illness: During the subsequent 3 years and 10 months she underwent x-ray examinations 8 times and those by endoscopy, 7. As is shown in Fig. 1, a niche was visualized thrice by x-ray. Changes in endoscopy pictures are also shown in Figs. 2～9. Gastric biopsy done 3 years and 8 months after the initial examination proved positive for cancer and gastric resection was performed in Jan. 1969 (3 years and 10 months later since the first examination).

　Findings of the excised stomach: They are shown in Figs. 10 and 11. The depression measured 5.0×6.0 cm. No open ulcer can be detected thereon.

　Histological findings: Adenocarcioma, m, (CAT Ⅱ, SAT 2) was seen almost in the entire area of depression. Fig. 12 shows that ulcer scars (Ul-Ⅲ and Ⅱ) are distributed within cancer nests like the letter L. Most of them are covered with non-cancerous regenerated epithelia, but in 2 sections are cancer tissues recognized.

　Conclusion

　Ulcers in this case came and went within an extensive, relatively shallow Ⅱc. The final diagnosis: early gastric cancer, Ⅱc＋Ⅲ. Endoscopy revealed that the ulcer A thrice enlarged and reduced in size. Ulcers were every time in the stage of “almost healed” within 1 or 2 months, although complete healing was observed only once. All together they showed a very favorable healing tendency. These ulcers resembled benign ones because not only ulcers extended along the transverse axis of the stomach but also indirect signs of ulcer such as rugal convergency became more manifest, but nevertheless they could be discriminated from benign ones in that the shape of ulcers was every time irregular, and even a shallow ulcer like B did not always heal within a short period.

　As compared with the initial stage, the surface pictures of Ⅱc around ulcers became more malignant, but for all that any positive finding to corroborate enlargement of Ⅱc area could not be obtained. Shallow ulcers recognized 2 years and 3 months prior to gastrectomy belonged to the sactuary type as proposed by Murakami, covered with regenerated epithelia. It is of interest that a part of it was covered with cancer tissue, showing a stratum-like transition to non-cancerous area.