Ⅱcと診断された良性潰瘍

A Case of Benign Gastric Ulcer (Ul-Ⅱ) Erroneously Diagnosed as Early Gastric Cancer (Ⅱc)

はじめに

　胃疾患の診断は，最近の目ざましい技術の進歩によって非常に正確になってきた．この症例は，まだファイバースコープや生検を行なっていなかった昭和42年のもので，レ線と切除標本から間違いなくⅡcと思われたのであるが，病理診断で良性潰瘍（Ul-Ⅱ）と訂正された例である．現在では，直視下生検などで誤診されることはないと思われるが，形態だけからはⅡcと極めて紛らわしい潰瘍もあるという点で興味深く，報告する．

　This study concerns a case of benign gastric ulcer (Ul-Ⅱ) histopathologicaiiy confirmed as such despite the fact that at first there had been no doubt about its being a Ⅱc lesion as judged by both x-ray and resected specimen.

　A 49-year-old female had three days prior to admission a sudden onset of epigastric pain associated with retching and vomitting. She could not recall any cause for it, either food, medicine or mental stress. In a screening x-ray survey at admission, deformity of the pyloric antrum was noticed so that she underwent minute examination. Photography of the anterior wall revealed a slightly oblong depression of irregular shape in the pyloric antrurn. Around the margins of the depression was visualized as well a typical club-like swelling of the mucosal folds with their abrupt cessation, so that the lesion was initially diagnosed as a Ⅱc lesion on the anterior wall. Later exposures of the posterior wall, although difficult to interpret owing to a great amount of air introduced into the stomach, disclosed that the depression had shifted over to the posterior wall. What looked like a Ⅱc lesion on the anterior wall was in fact caused by the pressure applied by a cotton pad. Va type gastrocamera was also employed, but good pictures were unavailable because of fog on the lens.

　Resected specimen disclosed a Ⅱc lesion at a site corresponding to that of x-ray on the posterior wall of the pyloric antrum. Histopathologieal diagnosis, however, was an open benign ulcer (Ul-Ⅱ).

　One of the reasons for erroneously diagnosing this lesion as Ⅱc was that the mucosal tips were swollen like clubs, owing to mucosal overhang formed by hypertrophy and hyperplasia of the surface epithelium at the margins of the ulcer.