Leser-Trélat の徴候により発見された胃癌の1例

Gastric Cancer with the Sign of Leser-Trélat, Report of a Case

　内臓悪性腫瘍に伴う皮膚変化としては，黒色表皮腫，皮膚筋炎，細網組織球腫，Gardner症候群を始めとする多くのものが報告され知られている．Leser-Trelatの徴候もこれらの皮膚変化の1つであり，高率に悪性腫瘍を合併することより，この所見が皮膚にみられた場合には消化管を始めとして各種臓器の検索を行うように言われてきた．われわれはLeser-Trélatの徴候をきっかけとして胃癌が発見された1例を経験したので報告する．

　A 78 year-old man had been diagnosed as having primary amyloidosis and had been treated in our institution since 1979. About the middle of March 1982, many hyperkeratotic papules with grayish-white scaling suddenly appeared on extensor side of the extremities. Microscopic examination of papules showed hyperkeratosis and papillomatosis. These findings were consistent with stucco keratoses. Leser-Trélat was suspected and referred to us for the examination of internal malignancies.

　X-ray and endoscopic examinations of the stomach revealed an irregular depression surrounded by nodular elevation on the posterior wall of the gastric angle and nodular elevation with central depression on the greater curvature of the antrum. These gastric lesions were diagnosed as Ⅱc＋Ⅱa type gastric cancer of the gastric angle and Ⅱa＋Ⅱc type gastric cancer of the antrum. The pathological diagnosis of the biopsy specimen from the gastric lesion was differentiated adenocarcinoma. Fourteen cases of an internal malignant tumor with the sign of Leser-Trélat have been reported in Japan. Eight cases of those were gastric cancers of which four were early gastric cancers.