3年1月経過を追求したⅢ＋Ⅱc型早期胃癌

A CASE OF Ⅲ+Ⅱc TYPE EARLY GASTRIC CANCER FOLLOWED UP FOR 3 YEARS AND 1 MONTH

はじめに

　筆者らは多数の胃潰瘍患者をfollow upしてきているが，最近まで多発性潰瘍と思って追跡していた症例の，多数の潰瘍のうちの1つが早期胃癌を疑わせる像を呈するようになり，手術をしてみたらⅢ＋Ⅱc型早期胃癌であった．この症例のX線，内視鏡フィルムをretrospectiveに振りかえってみると，3年1月以来の数回のX線，内視鏡フィルムにも，その病変部の異常を指摘し得ることを知ったので，興味ある症例と考えここに報告したい．

　Many gastric ulcer cases are now being followed up in the authors' department. The case here presented had also been followed up as of multiple gastric ulcers until recently, when one of its lesions began to be suspicious of early cancer. By operation it was proved to be Ⅱ+Ⅱc type early gastric cancer. It is of interest because retrospective study of this case reveals that in the initial endoscopic pictures taken 3 years and 1 month before as well as those of subsequent follow-up, abnormality of the lesion could be recognized.

　Case: T. T., a 57-year-old schoolmistress, had been diagnosed as of duodenal ulcer in Jan. 1964. She was referred to the authors' department after being treated by her doctor since Dec. 1965 because of epigastric pain, sensation of fullness and loss of weight. Her aversion to surgical intervention enabled the authors to follow up her case until recently. As of her admission to the hospital, her present status showed no abnormality and various laboratory data were within normal limits except for hyperacidity of gastric juice. Endoscopic and x-ray studies of the stomach, done 6 and 9 times respectively since Feb. 2, 1966, revealed alternate phases of healing and aggravasion of gastric ulcer on the lesser curvature at the angle. However, a depressed lesion on the anterior wall of the antrum a little toward the pylorus, already recognized by GFT examination on April, 1966, began to be excavated increasingly, at first like Ⅱc and then like Ⅲ+Ⅱc, so that operation was performed on May 19, 1969. The lesions were postoperatively confirmed as multiple ulcers of the stomach and duodenum, and one of the ulcer lesions located on the anterior wall of the antrum proved to be Ⅲ+Ⅱc type early cancer. It was Ul-IV, being adenocarcinoma tubulare, partially reaching the muscularis mucosae.