“いわゆるビラン性胃炎”の経過観察中に発見したⅡa＋Ⅱc型早期胃癌の1例

A CASE OF Ⅱa+Ⅱc TYPE EARLY GASTRIC CANCER DETECTED IN THE COURSE OF FOLLOW-UP OF SO-CALLED GASTRITIS EROSIVA

はじめに

　近年の胃X線，内視鏡検査の進歩は極めて小さい早期胃癌の発見を可能にすると共に良性疾患としての“いわゆるビラン性胃炎⁶⁾”の診断をも容易にし，筆者らも日常しばしばその診断を下している．しかし“いわゆるビラン性胃炎”は過酸，過分泌，過緊張，粘膜過敏性などの胃X線，内視鏡検査にとって不利な条件を備えていることが多く，まれとはされているがこれに微細悪性病変が併存する揚合にはその診断はかなり困難である．

　筆者らは“いわゆるビラン性胃炎”の経過観察中初診より5年後に幽門前庭部のⅡa＋Ⅱc型早期胃癌を発見したので，ここに報告し若干の考察を加えてみたい．

　Recently a case has been experienced which was confirmed 5 years after the initial examination as of Ⅱa+Ⅱc type early gastric cancer on the posterior wall near the pyloric ring while the patient was subjected to periodic follow-up study of “so-called gastritis erosiva” associated with duodenal ulcer. The case, a 63-year-old male having hematemesis as his chief complaint, was examined for the first time in May 1963. Because of the presence of active duodenal ulcer and hyperacidity of gastric juice as Well as positive results of various examinations, he had been followed up since then until Sept. 1966 as a case of typical “so-called gastritis erosiva” to be observed every 6 month or once a year at the most. In Aug. 1968 he had a bout of hematemesis and by thorough examinations of his stomach it was found that besides gastritis erosiva there was a Ⅱa+Ⅱc type early cancer lesion in the greater curvature sicle of the posterior wall near the pyloric ring. It was well defferentiated adenocarcinoma of a size of 1.5 by 3.0cm, partly infiltrating into the submucosa. Erosions were noted in the surrounding areas. Retrospective study of this case reveals that in the gastrocamera pictures taken 6 months after the initial examination there is seen on the posterior wall near the pyloric ring a protuberance, only slightly elevated from the adjoining mucosa, and this protrusion is assumed to account for early changes of gastric cancer.

　As due regard must be paid in the diagnosis of early gastric cancer to the fact that it can be associated with gastritis erosiva, this case is reported in this paper with some comments on it.