多発性胃潰瘍として経過観察したⅡc＋Ⅲ＋Ⅱb型早期胃癌

A Case of Ⅱc＋Ⅲ＋Ⅱb Type Early Gastric Cancer First Suspected as Multiple Gastric Ulcer

　最近筆者らは胃体部大彎側前壁の多発性胃潰瘍として経過観察中，胃生検でgroupⅣの結果を得て手術を施行したところ，その切除胃病理診断で意外に癌浸潤が広範囲であった早期胃癌症例を経験したのでここに報告する．

症例

　患　者：村○正○　66歳　男性

　主　訴：心窩部痛

　家族歴；特記すべきことなし．

　現病歴：昭和46年3月末頃より食後約30分ないし60分後に背部へ放散するような心窩部痛を訴えるようになった．上記症状は約1カ月間持続した．昭和46年5月精査のため当院外科外来を受診の際は自覚症状は全くなかった．胃透視，胃カメラの検査の結果，多発性胃潰瘍として経過観察され，同年6月再度胃透視，胃カメラの検査を行なった結果，早期胃癌を疑われ，胃生検を受け，groupⅣの診断で手術を目的として入院した．

　The patient is a 66-year-old man. His chief complaint is postprandial pain in the epigastrium. He visited our hospital for thorough check-up because of the above symptom he had felt since about one month before. The initial fluoroscopy and gastroscopy disclosed an active ulcer on the anterior wall of the lower corpus associated with an ulcer scar in its greater curvature side. Several mucosal folds were also seen to converge toward the center of the scar. He was then placed under observation because the clinical course of the disease as well as various examinations failed to suggest any active malignancy. However, at the second fluoroscopy and endoscopy done about 40 days later we suspected that the lesion on the anterior wall of the lower corpus could have been a manifestation of a malignant cycle of early ulcercancer. Gastric biopsy confirmed our suspicion : it was group Ⅳ. Gastric resection was accordingly performed.

　Both macroscopic findings and histopathological diagnosis showed it to be a Ⅱc＋Ⅲ＋Ⅱb early cancer. Carcinomatous infiltration was more extensive and complicated than we had anticipated before the operation. It was because x-ray and endoscopy both failed to accurately visualize not only papillar elevation within the Ⅱc lesion but adjoining Ⅱb part as well. Of added interest was this elevation was histologically recognized as pseudo-papillar hyperplasia of tubular adenocarcinoma.

　The case here described shows that early gastric cancer, especially of depressed varieties, does often simulate benign ulcer. Even multiple benign ulcers may harbor malignancy within them, so that their energetic follow-up should not be neglected.