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Ⅰ.まえがき
われわれは多数の胃潰瘍を治癒後も厳重にfollow upしているが,その瘢痕化したように思われた潰瘍部位より,癌化したと考えられるⅡc+Ⅲ+Ⅱa型早期胃癌を経験したのでここに報告する.
We do the strict follow up studies on the gastric ulcers after their healing. One case of Ⅱc+ Ⅲ+Ⅱa type early gastric cancer which seemed to be appeared at the site of healed ulcer that had changed into scar tissue, was experienced and presented.
The patient was fourty three year old male, who was technician. His chief complaint was epigastric pain when he was hungry. He visited our clinic on 27th July '66. Gastrocamera examination on 28th July and X-ray examination on 5th August were performed and a 3×3mm ulcer was found at the anterior wall of the angulus. He was admitted and treated. By GTF examination on 17th Oct. and X-ray examination on 21st Oct., no niche was noticed and he was discharged on 21st Oct. '66. No change was found by X-ray examination on 24th Nov. '66.
But by GTF examination on lst May and 3rd June '67 and by X-ray examination on 16th May '67, the color change, breaking down of the gastric folds, recurrent ulcer with an irregular margin and infiltrative thickness around the ulcer were observed. The opration was performed on 5 th Iune '67. Operative findings were So Po Ho No and post operative course was uneventful. The patient was discharged two weeks after. Macroscopically, the ulcer formation 1.0×1.0cm in size at the lesser curvature of the angulus was seen. This ulcer had changed into scar tissue. Around this ulcer, a flat erosion 3.5×4.0 cm in its spread with irregular form was noticed. This ulcer was Ul-Ⅱ type and at the bottom of the "ulcer, defect of the mucous membran and its regeneration were seen. The muscularis mucosa at this part was broken off and a fibrinous change was seen at the submucous and the muscle layer. Adenocarcinoma tuburale was found at the part of the erosion around the ulcer. Some part of it showed mucous degeneration. Cancer was restricted in the mucous membran.
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