多発性早期胃癌の1例

Multiple Gastric Cancers, a Case Report

　多発性早期胃癌の症例は，最近増加しており，しかもかなり高い頻度で術前診断されるようになってきている．私どもは，胃角上部のⅡa型早期胃癌の発見が動機になり，他に病変の存在をX線的，内視鏡的に検討を加え，胃角上部のⅡaに連らなって前壁にⅡc，角部後壁にⅡc，前庭部後壁大彎寄りに比較的小さなⅡc，それよりやや口側の前庭部大彎にⅡcを発見診断できた多発性早期胃癌と，前庭部小彎前壁および胃体部後壁に異型上皮を合併する1例を経験したので，ここに若干の考察を加えて報告する．

症例

　患　者：大○和○　♂　69歳

　主　訴：1年半位前より胃部不快感および空腹時心窩部痛を時々感じる．

　既往歴：2年前に肺結核．

　入院時所見：胸部X線写真にて右肺尖部に結核性硬化性陰影を指摘できる．血圧は150～90（右）でほぼ正常．血沈1時間値2，血液一般検査にて，赤血球数478×10⁴，血色素量15.4g/dl，Ht 48％，白血球数7,400，生化学，肝機能検査は異常を認めない．腎機能検査，心電図も異常を認めない．X線精密検査2回終了翌日の白血球数は8,300と異常を認めていない．検便潜血反応は陽性で，胃液検査は無酸．

　Multiple early cancers of the stomach are increasingly encountered in recent times, and their preoperative diagnosis is also made in a high percentage. Of late we have come across a Ⅱc type early cancer above the angle, which has prompted us to look for other possible lesions both by x-ray and endoscopy. They did exist. We have found a Ⅱc on the anterior wall adjacent to the first lesion, followed byc a Ⅱ on the posterior wall of the angle, further by a relatively small Ⅱc on the posterior wall of the antrum on the side of the greater curvature and finally by another Ⅱc oral from the last lesion on the same side of the antrum. All told we have additionally found four lesions of early cancer of the stomach. The present case was also associated with two areas of atypical epithelium, one on the anterior wall of the antrum in the lesser curvature side and the other on the posterior wall at the level of the angle.

　The case here described has given us a lesson not to be satisfied with the detection of a single lesion but to look for other possible concomitant lesion throughout the stomach. Their presence or absence should always be ascertained. Evaluation of the resected stomach must always be done carefully along with postoperative follow-up the patients' courses.