多発性早期胃癌の1例

A CASE OF MULTIPLE EARLY GASTRIC CANCER

Ⅰ．はじめに

　最近では早期胃癌症例も多数報告され，それらの材料をもとに組織発生学的検索が進められている．一方，癌の多中心性発生の問題にからんで多発胃癌がとりあげられ，いろいろ興味ある問題を提起している．

　われわれは，胃X線所見，胃内視鏡所見および胃生検所見からⅠ型およびⅡa型の多発早期胃癌の臨床診断が与えられ，切除標本の組織検索によってこれが確認された多発早期胃癌の症例を経験したので報告する．

　Case: a 67 years old farmer, male. As gastric polyp and ulcer were found at a gastric mass survey, he came to the authors' department for thorough check-up. He had no subjective complaints and laboratory data such as of feces, blood and liver function remained within normal limits. The gastric juice was of hypoacidity. At x-ray examination of the stomach, a ployp having a long stalk was suspected in the greater curvature side of the lower body, in addition to a Ⅱa type protruded lesion above the gastric angle. Endoscopic study of the stomach revealed a medium-sized polyp with a very long stalk on the anterior wall in the greater curvature side of the lower gastric body. The head of the polyp, engorged and uneven, was accompanied with erosions, but neither bleeding nor necrosis was demonstrated. There was also found a low mucosal elevation of irregular shape having rough and uneven surface, located on the lesser curvature of the lower corpus. These two lesions were endoscopically suspected as of type I and Ⅱa, while by biopsy they were confirmed to have a picture of malignancy in the former and that of chronic gastritis in the latter. In the resected specimen was found, in the same site as of the endoscopic picture, a polyp with its head measuring 1.5×1.0×0.9 cm and having a stalk 1.2 cm long 0.4 cm in breadth. A protruded lesion, measuring 2.3×1.6×0.3 cm and of engorged and uneven surface, was also found above the gastric angle. Histological study by means of serial sections revealed malignant change in a part of the mucosal layer in the head of the polyp. In the protrusion was also found a cancer lesion, which had partly invaded the submucosal layer through a gap in the lamina propria. As there was neither cancerous infiltration between these two lesions nor any metastasis to lymph nodes, this case was diagnosed as of multiple early gastric cancer of type Ⅰ and Ⅱa.