急性骨髄性白血病と合併した噴門部潰瘍の1例

A Case of Cardiac Ulcer Associated with Acute Myeloblastic Leukemia

はじめに

　筆者らは最近，噴門部潰瘍の患者を約半年間外来にて経過観察を行なったが，途中，白血病を併発したため，レ線および内視鏡学的にその胃粘膜像の把握に難渋し，胃上部病変，ことにBorrmannW型の胃癌との鑑別に種々な示唆を与えられた．また胃病変の診療においても，単に病変を局所的に把握するのではなく，常に全身的な立場から考えなければならないことを改めて痛感させられた．

　In the course of a follow-up for about 6 months in the outpatient clinic of cardiac ulcer in a 61-year-old male, mucosal folds as of encephaloid appearance were observed roentgenologically in the upper segment of the stomach in addition to irregular granular changes of the mucosa of various sizes, while endoscopically an ulcer scar was observed on the posterior wall directly beneath the cardiac orifice together with engorged changes in the mucosal granulae, various in sizes and now scattered about and now confluent. These changes proved to be caused by gastric manifestations of acute leukemia which later accompanied the preceding cardiac ulcer. At first it was very hard to arrive at an exact diagnosis because there had been on abnormal finding in the bood, nor were there almost any systemic changes. General prostration was so sudden that biopsy was not performed.

　This case is of great interest as it made the authors aware of the necessity of general investigation of the patient even in the diagnosis of gastric diseases. A reference is also made to autopsy findings as well as to vasious phases of gastrointestinal involvement in acute and chronic leukemias together with their incidence in this respect.