Addison-Biermer悪性貧血の胃癌合併例について

A Case of Addison-Biermer's Pernicious Anemia with the Complication of Gastric Cancer

　Addison-Biermer悪性貧血（以下悪貧と略）は欧米人に比較し，東洋人にはまれといわれる．入院患者総数に対する悪貧比率をHeilmeyer 0.46％，Friedlander 0.61％というのに対し，本邦では河北0.174～0.02％，美甘0.126％，沖中内科0.06％ときわめて少ない．しかし，悪貧に胃癌がしばしば合併することは定説になっていて，文献上では，動揺はあるにしても，多いもので悪貧例数の約6～15％に胃癌合併を認めているが，日本では，症例報告が散見するに過ぎず，胃癌の多いわが国において，悪貧と胃癌との関連がどうなっているのかは不明といわざるをえない．筆者らは過去15年間に悪貧10例を観察した．そのうち生存を確かめている7例についてみると，悪貧推定発症より1970年1月末までの期間は4年8カ月を最短とし，15年7カ月におよんでいる．これらの症例群のうち，発症より7年6カ月後に早期胃癌を認めた1例を経験したので報告し，あわせて本邦悪貧，胃癌合併例について考察したい．

　The actual incidence of gastric cancer in AddisonBiermer's pernicious anemia in Japan to date has not been clarified. During the past 15 years we have experienced 10 cases of pernicious anemia with follow-up studies in some. The complication of gastric cancer was also experienced.

　The literature from 1950 to 1969 was reviewed for cases of pernicious anemia with the complication of gastric cancer.

　a) A case of pernicious anemia in which an early gastric cancer type Ⅱa+Ⅱc and Ⅱa was noted in the antrum 7 years and 6 months after onset is presented.

　b) Among 257 cases of pernicious anemia collected from the literature during the above-mentioned period of time, gastric cancer was demonstrated in 14. A review of these cases revealed the following facts.

　1) In our country, the frequency of pernicious anemia itself is rather low, but that of gastric cancer as a complication is not markedly different from that in Europe and America.

　2) The longest interval between the onset of pernicious anemia and the time of the diagnosis of gastric cancer was 7 years and both diseases were simultaneously diagnosed in some cases.

　3) Among 14 cancer lesions (11 cases), 5 were located superior to the corpus.

　4) Polyp-like or elevated lesions constituted the majority.

　5) In 4 cases, multiple cancer lesions were found.

　6) No characteristic features were evident in the histological picture of the cancers.