線状潰瘍瘢痕上にみられたⅡc型早期胃癌

A CASE OF AN EARLY GASTRIC CANCER ON THE SCAR OF A LINEAR GASTRIC ULCER

Ⅰ．まえがき

　胃癌発生母地に関しては古くから多くの論争がなされてきたが，臨床診断法の進歩と共に種々多彩な早期胃癌が発見され，多くの知見が得られるに及んで新たな論争が起っている．本例もその特異な所見から，発生母地に関して一つの示唆を与える症例ではないかと思われる．

　Recently with remarkable improvement in diagnostic method of gastric cancer, many cases with early gastric cancer on ulcer scar have been reported.

　This is a case of early gastric cancer which spread linearly and superficially on a linear gastric ulcer scar.

　Case: 44 years old, male.

　A cascade deformity of the stomach and a linear niche extending from the angulus to the posterior wall were found by routine X-ray examination. By gastrofiberscopic study, a typical early gastric cancer (type Ⅱc) was demonstrated on the anterior wall near the angulus, from which a linear discolored area was extended toward the posterior wall. The result of gastroscopic cytology was class V. A poorly differentiated adenocarcinoma was histologically diagnosed with specimens taken by gastroscopic biopsy. Thereafter, a carefull reexamination with X-ray showed difinite findings to suspect an early gastric cancer.

　The surgical resected specimens showed a depressed lesion with irregular edge 20×10mm in diameter on the anterior wall at 70 mm apart from the pyloric ring. The border of the lesion was sharply demarcated on the side of the greater curvature, but it was not clear on the other side and slightly discolored linear area was extended toward the lesser curvature.

　In this portion, a linear gastric ulcer scar was found microscopically, and the lesion of poorly differentiated adenocarcinoma 70×25 mm in diameter which stayed in mucosa surrounded completely regenerated epithelial cells on the scar.

　The ulcer-cancer relationship in the development of ulcerating carcinoma is still obscure. Since a linear carcinoma in the stomach is extremely rare, carcer in this case seems to originate from the mucosal cell around regenerated epithelium on the ulcer scar rather than linear cancer was ulcerated.