経過を観察しえたスキルスの1例

A Followed-up Case of Gastric Scirrhus

　初診時X線検査で胃潰瘍と診断，その後約8カ月，再来時X線検査でスキルスと判明した症例を報告する．

　On account of undetermined gastric complaint arisen since eight years before, a 30-year-old man had been treated in one hospital after another under a diagnosis of either gastric or duodenal ulcer. Our initial roentgenologic examination revealed a sharply demarcated ulcer of rather irregular shape the size of a small-finger-tip on the posterior wall of the midbody. As the surrounding mucosa was hardly altered we decided to follow him up with a suspicion of malignancy. Soon he was lost to follow-up. When he came back to us again after about eight months, his complaints were worse than before and his health was generally deteriorated. Roentgenography revealed such a clear-cut hour-glass stomach as to enable us to make a diagnosis of typical scirrhus carcinoma of the stomach. Approximately in the same site as the former niche was seen again a niche the size of a index-finger-tip. Its shape was irregular. The surrounding mucosa showed definitely malignant changes on both sides of the curvatures. Surgical operation was carried out immediately. Unfortunately cancer recurred one year and two months later and the patient died of concomitant peritonitis carcinomatosa.

　Early diagnosis of gastric scirrhus is as yet faced with many unsolved problems. Retrospective study of the workup in this patient also confirms this fact. A most important clue to the detection of scirrhus carcinoma in the stomach is believed to look for cancerous erosions accompanied with shallow ulcer lesions. If so, would it have been possible to do so in the present case？ If pictures more exact and truer to life had been taken, we might have succeeded. Prone mucosal pictures, if well taken, would also have been welcome. Furthermore, another one or two examinations should have been done during the long blank of eight months. At all events, it goes without saying that not only faithful depiction of a given lesion should be done to the best of the examiner's ability but also the patient should be thoroughly and repeatedly examined whenver a slightest suspicion of malignancy is entertained. This is a basic principle common to all confirmatory examinations. In another case of gastric scirrhus we have come across the patient complained of pain as considerable as the present case. We wonder if it had been a more coincidental complaint.