線状潰瘍に合併した早期胃癌（Ⅲ＋Ⅱc）の1例

A Case of Early Gastric Cancer (Ⅲ+Ⅱc) Associated with Linear Ulcer

　一般に線状潰瘍と早期胃癌との合併は少ないとされている．この例は胃レ線での描写は難しかったが，胃内視鏡診断では割合に容易に悪性像を把握された．しかし，きめ手になるべき胃生検検査では癌細胞が検出され得ず，手術後の切除標本の肉眼的観察でも悪性変化の把握が難しかった．また軽い慢性膵炎も証明され，長年の自覚症状は，いわゆる膵庇護療法を行なうことで手術前に消失してしまうなど，種々の示唆を与えられた．

　The patient, a 42-year-old man, had right hypochondrial pain since two years before. As an abnormality was found in the function tests of the pancreas, he was medically treated under a diagnosis of chronic pancreatitis, and his subjective complaints subsided. Overlooked at the initial x-ray examination of the stomach, the lesion was revealed later by gastrocamera as a linear ulcer extending to both walls at the level of the angle. Malignant changes around it such as engorgement, small elevations and cessation of the rnucosal folds were demonstrated as well. T he ulcer was confirmed by the second x-ray examination and malignancy was strongly suspected. Gastric biopsy done on six specimens taken from around the ulcer proved negative for cancer. The lesion was finally diagnosed as cancer by the third x-ray examination donel one month later. Operation was accordingly performed.

　Pathological findings: A linear ulcer scar about 6cm long was seen extending from the anterior to posterior walls at the height of the incisura. Cancer infiltration was seen in an irregular, linear fashion in the area surrounding the whole extent of the linear ulcer. Histologically, the greater majority of cancer cells were of mucocellular carcinoma simplex with a partial formation of small tubule. Depth invasion of cancer mostly remained within the mucosal layer, although it was seen partly well within the ulcer scar.

　X-ray and biopsy of the stomach failed to reveal cancerous change in this case, and endoscopy alone succeeded in verifying early cancer associated with linear ulcer. Histological findings seem to suggest that ulcer lesion preceded cancer origination.