3年5ヵ月経過観察した異型上皮の症例

A Case of Atypical Epithelium Followed up for Three Years and Five Months

Ⅰ．症例

　患者：杉○太○　51歳　男

　主訴：なし

　家族歴：特記すべき事項なし

　既往歴：赤痢（25歳）

　現病歴：1966年2月に肝腫大のため某医に於いて全身の検査を行なった結果，胃レ線像に異常所見ありといわれ，精査のため来院した．初診時連続3回レ線検査を行なったが確診が得られず，1966年4月に胃カメラ検査を行なった．その結果，胃体下部の小彎より後壁に小さな平盤状隆起を認めたが良悪性を定めることができぬまま観察することにした．66年11月および67年1月に生検を行ない，第2回目にようやく良性異型上皮を検出した．以後，ほぼ定期的に生検，レ線，内視鏡による経過観察を行なったが，ある時点で生検によりⅡa型早期胃癌（GroupⅣ）と診断されたため，1969年9月1日に胃切除を行なった．

　In a 48-year-old man a plateau-like protrusion was confirmed on the posterior wall of the corpus by a gastrocamera examination in April 1966. By its biopsy in January 1967, it was diagnosed as atypical epithelium (Group Ⅲ). For three years and five months, or hiopsically two years and eight months thereafter up to the time of surgical operation, it had been closely followed up. In the interim, every two to five months gastric biopsy was done altogether eight times. Five biopsical examinations during the first one and a half year showed that the diagnoses were always atypical epithelium (Group Ⅲ), but succeeding seventh and eighth examinations revealed it to belong to Group IV. Histopathological findings of the removed stomach also revealed there was a part of tubular adenocarcinoma in the resected specimen (CAT I, SAT 1, INFα, m). As far as biopsy is concerned, this result shows that transition from benignancy to malignancy has been observed. During its entire course no growth of the tumor was recognized.

　Because the period of observation was fairly prolonged, the patient has begun to show signs of unrest and impatience. If one is to take a patient's mental burden into account, a Ⅱa-like protrusion in the stomach, even if it be only an atypical epithelium, should be considered as an indication for surgical removal with due allowances for his physical and social conditions. Especially when he is under sixty, it should be regarded as equally malignant as cancer.