胃壁硬化が軽度な状態で診断された胃体部スキルス（linitis plastica型胃癌）の1例

Scirrhous Cancer of the Gastric Corpus in Relatively Early Phase, Report of a Case

要旨　患者は59歳，女性．約4年前より糖尿病にて通院中，貧血（浮遊感）を来し入院．体重減少なく，栄養良．一般検査上，貧血（RBC：229×10⁴，Hb：6.7g/dl）以外異常なし．X線，内視鏡検査で体下部前壁にⅡc様陥凹を認め，その口側と大彎側の雛襞は軽度の肥厚と直線化や鋭利な屈曲蛇行を示し，同部に伸展障害を認めた．小彎側の雛襞は陥凹部に集中するも大彎側からの雛襞集中像はなかった．胃全摘術を施行，病理学的にはsig，SSγ，1y₂，v₀，n₁（＋），n₂（－）であった．原発巣（長径2cm，Ul-Ⅱ）は胃底腺領域内にあり，癌が胃体部前壁のほぼ全域（14×6.5cm）の粘膜下層以下に線維化を伴いつつ浸潤するスキルス（linitis plastica）であった．

　A 59 year-old woman, who had been treated for diabetes mellitus since four years before, felt a floating sensation due to anemia, and was admitted to our hospital on October 1, 1984. There was no body weight loss. Laboratory data showed no abnormality except anemia (RBC; 229×10⁴/mm3, Hb; 6.7 g/dl).

　X-ray and endoscopic examination (Figs. 1-4) revealed a small ulcerative lesion, simulating type Ⅱc early gastric cancer, in the anterior wall of the lower corpus. Thickened and straightened mucosal folds were recognized on the oral side of the depressed lesion, and tortuous folds were shown in the greater curvature. There was a slight disturbance of the distensibility of the gastric wall where the above folds were seen. Mucosal folds in the lesser curvature converged to the depressed lesion, but other folds ran in parallel without convergence.

　Pathological findings were summarized as signet-ring cell cancer (Fig. 7b), ssr,1y₂, v₀, n₁ (+), and n1 (-). The primary ulcerative lesion, whose size was 2 cm at its largest diameter, and deepest part was Ul-Ⅱ histologically (Fig. 7a), and it was within the fundic gland area. Cancer cells had infiltrated into the submucosal and further deep layers with a lot of fibrous tissue (Fig. 7c), and had extended from the lower corpus to the fundus in the anterior wall (14×6.5cm) (Fig. 5, 6). Therefore, the diagnosis of this case was scirrhous cancer of the gastric corpus (linitis plastica) in a relatively early phase.