胃癌を合併した皮膚筋炎の1例

Dermatomyositis Associated with Gastric Cancer, Report of a Case

　1916年，Stertzにより皮膚筋炎と胃癌の合併例が初めて報告されて以来，本症と悪性腫瘍の合併が注目されてきた．本邦では1955年，加瀬らによる36歳，男子の胃癌合併例を嚆矢とし，以来胃癌合併例の報告が多く，胃癌は本症に合併する悪性腫瘍の40～50％を占めている．最近，われわれは皮膚筋炎に胃癌を合併した症例を経験したのを機会に自験例を含めて本邦報告例および日本病理剖検輯報に記載されている胃癌合併例を選び出し検討を加えたので報告する．

　A 71 year-old man was admitted in November 1981 with a four-month history of an edematous erythema on the scalp, face, and upper chest. He also had muscle weakness and myalgia of the buttocks and lower extremities seven months ago. Laboratory examinations showed an elevated erythrocyte sedimentation rate (48 mm in first hour),SGOT 44 mIU, SGPT 21 mIU, LDH 502 mIU, serum creatinine phosphokinase 350 mIU, urinary creatine 176 mg/day, and neurogenic pattern in electromyogram. A biopsy specimen of the erythema, obtained from the neck, showed atrophic epidermis, liquefaction degeneration, and edema in upper part of the corium. A muscle biopsy of the deltoideus revealed an inflammatory cell infiltration and no degeneration of the muscle.

　Roentgenograms of the complete gastrointestinal tract showed no abnormality (Figs. 3, 4).

　Then, treatment with orally administered prednisolone, 60mg/day, was started in November 1981. The prednisolone dosage, for the disappearance of erythema and decrease of muscle enzyme values, was decreased to 40 mg/day. Therefore, the patient had a recidivation of erythematous eruption and diabetes mellitus. In December 1981, he developed an upper abdominal pain before meal. Re-examination of the gastrointestinal tract, performed in February 1982, revealed an elevated lesion with ulcer, measuring 40×45 mm, on the antrum of the stomach. Subtotal gastrectomy with lymphadenectomy was performed in March 1982. Pathological findings was poorly differentiated adenocarcinoma invading over the serosa with metastasis in the pancreas, mesocolon and lymph nodes. The patient, with temporary remission after the operation, died of DIC in May 1982.

　We investigated 73 cases of dermatomyositis associated with gastric cancer in Japan. (1) 96％ of patients were more than 40 year-old. (2) 90％ of patients was discovered a gastric cancer within a year after the diagnosis of dermatomyositis. (3) Many patients had the advanced gastric cancer. (4) 71.4％ of patients performed a gastrectomy died within a year.