多発早期胃癌の1例

A CASE OF MULTICENTRIC EARLY GASTRIC CANCER

Ⅰ．はじめに

　近年日本に於ける早期胃癌診断学の進歩は驚異的なものである．後ればせながら，台湾にいる私たちも，1965年2月に町田製ファイバースコープ，FGS-A型，1967年7月にはFGS-B型及び胃カメラGT-V，GT-Va，本年はFGS-S型等を相次いで手に入れ，爾来，全部員の努力に依り現在迄にファイバースコープ検査約500例，胃カメラ検査約540例施行してきた．特に去年七月初旬より，早期胃癌発見を目ざしてできる限り外来患者には，Chest P-A X-ray検査が既にルーチンであると同様に，胃部症候主訴の有無にかかわらず胃内視鏡検査（主に胃カメラ，それから精検としてファイバースコープ）をルーチンとして提唱してきた．次に示す症例は斯くして得られた貴重な胃前庭部前壁2個（Ⅱa＋Ⅱc，Ⅱa＋Ⅱc），胃前庭部後壁1個（Ⅱc）の多発早期胃癌例（Multicentric Early Cancer，Ⅱa＋Ⅱc，Ⅱa＋Ⅱc，Ⅱc）の1例である．

　Patient: Male, 63 years of age, a native of Honan Province, Mainland China. Main Complaints: Dull pain in the upper abdomen, and anorexia. Present Ailments: Starting approximately from May of 1967, the patient suffered an obtuse pain in the upper abdomen. The decrease of appetite resulted in the loss of weight.

　Anamnesis: High blood pressure, and the after-effect of the stroke (for the past five years). The patient underwent the total extraction of his left lung on Sept. 19, 1966. Pathological examination revealed the existence of adenocarcinoma of the lung and tuberculosis.

　Examinations: In July of 1967, the first application of the fiberscope and the gastroscope revealed a polyp on the greater curvature at the level of the gastric angle, together with the depression (Type Ⅱa ＆ Ⅱc) on the anterior wall of the vestibule, surrounded by five or six small elevations and a small prominence on the posterior wall of the vestibule as well.

　Additional examinations were carried out five or six times, and with the help of the biopsy under direct view the atypical glandular structure was detected.

　X-ray examinations were carried out three or four times, during the period of from Aug. 3 to Oct. 20, 1967. The compression studies were helpful in revealing one protruding lesion each in the vestibular region and on the greater curvature. The former was diagnosed to be Type Ⅱa ＆ Ⅱc, while the latter was suspected to be Type I because of its polyp-like appearance.

　The excision of the stomach was carried out, and the lesion on the anterior wall of the vestibule was confirmed to be Type Ⅱa ＆ Ⅱc pathologically. In addition, another one of Type Ⅱa ＆ Ⅱc was found close by, and another of Type Ⅱc on the posterior wall of the vestibule.

　Thus this case is believed to be rnulticentric early gastric cancer (Type Ⅱa ＆ Ⅱc, Ⅱa ＆ Ⅱc, Ⅱe), arising from the so-called chronic gastritis. Moreover, it is a case of veritable double cancer (adenocarcinoma in the left lung and the early stage of stomach cancer).

　This case is the very first one of the early stage stomach cancer which we detected with the application of the gastroscope.