良性ポリープとⅠ型およびⅡa型早期胃癌の合併症例

A CASE OF EARLY GASTRIC CARCINOMA OF TYPE Ⅰ AND OF TYPE Ⅱa ASSOCIATED WITH BENIGN POLYP

Ⅰ．症例

患者：73歳　♂

主訴：空腹時痛

既往歴：20歳頃から胃腸症状があり，時々売薬を服用していた．30歳頃，黄疸に罹患したことがある．

現病歴：昭和42年6月頃から食欲不振があり，10月中旬頃から空腹時痛を来たすようになり，11月14日，当センター受診．

　This is a report of a case of multiple cancer of the stomach (type Ⅰ and type Ⅱa) associated with benign polyp.

　The patient, a 73 years old male who had been in good health, had begun to feel loss of appetite in June, 1967, and three months later developed hunger pain. He visited the authors’ clinic on Nov. 14. At X-ray and gastrofiberscopic examination, three mucosal protrusions were found, ranging from the angulus down to the antral cavity. It was decided to follow them up.

　On May 13, 1968, he was admitted to the authors’ hospital for a thorough check-up. Roentgenologically, a polyp was found in the angulus as well as type I protuberance located on the lesser curvature of the antrum and close to it a Ⅱa type protrusion was also noted on the anterior wall. Endoscopical findings fairly corresponded with those of X-ray films, and the overall diagnosis was type I (presumptive) and type Ⅱa early gastric cancer concomitant with a benign polyp. The diagnosis was at once confirmed by sniping biopsy under direct observation by means of FGS-BL, as it enabled the examiner to differentiate benign polyp from two malignant lesions preoperatively. Macroscopic and pathohistological findings of the resected stomach showed the same result.

　As for the biopsy of type I protuberance, atypical epithelium was disclosed in four specimens out of five, and the fifth showed malignant cells. On closer examinaton of the excised stomach, it was revealed that malignant cells were limited chiefly in the anal side of the lesion, and only atypical epithelium was found in its oral side.

　In the diagnosis lesion, this case is very instructive in that it shows the importance of sniping biopsy if it is done of sucha from as many parts of the stomach as possible.