胃生検で確診しえた胃重複癌症例

A Case of Double Cancers of the Stomach Demonstrated by Biopsy

　胃内視鏡検査の中で，直視下胃生検は不可欠なものとなり，胃生検が胃診断学に貢献した功績は，極めて大きい．しかし生検検査濫用のため，X線，内視鏡の読影がなげやりになって，万事生検に依存するといった傾向があるとしたら重大事である．本稿では筆者らが最近経験した胃重複癌症例で，胃体部後壁の潰瘍を経過観察中，幽門部のⅡc病変に気付き，生検にて確診しえた症例を経験したので供覧し，かつ胃生検の持つ役割とその問題点につき，若干の考察を加えた．

　Although gastric biopsy has greatly contributed to the diagnosis of gastric lesions, it should always be performed after careful interpretation of findings obtained by roentgenography and endoscopy. It must not be done too easily. The role of gastric biopsy and its problems are discussed here based on a case of double cancers of the stomach recently encountered that was confirmed as such by biopsy.

　An ulcer on the posterior wall of the body in a man 69 years of age was followed up for as long as one year and a half. In the interim cancer was finally demonstrated after the fourth biopsy. During the follow-up period we had also noticed another Ⅱc lesion in the pyloric antrum which was, retrospectively studied, seen as an x-ray finding (suggesting an abnormality near the pylorus) that should have been interpreted more cautiously. Biopsy during the follow-up of ulcer must always be done under careful interpretation of x-ray and endoscopy findings. It should be repeated whenever occasion requires. The fact must always be taken into account that recurrent or intractable ulcer may show “malignant”. Cases in which biopsy was negative for cancer should be treated very carefully. Whenever slightest cause for suspicion of cancer arises in findings of x-ray and endoscopy, active rebiopsy is strongly recommended.