悪性貧血と多発性早期胃癌合併の1症例

A Case Report of Pernicious Anemia Associated with Multiple Early Gastric Cancers

　悪性貧血(以下PA)には，胃癌合併率が高いといわれているものの，わが国においてはPAは比較的稀な疾患であり，胃癌合併例の報告は少ない．最近PAに対して，自己免疫学的立場からの追究，さらに高ガストリン血症と体部腺萎縮型胃炎との関連が注目されている．われわれは，PAに2コの早期胃癌を合併した1例を経験したので，特にその胃炎像について考察したい．

　In our country, the incidence of pernicious anemia is rather low, and there have been only a few case reports of pernicious anemia associated with gastric cancer. We report here a case of pernicious anemia associated with early gastric cancers of type IIa and type IIc.

　A 51-year-old male was admitted to our hospital, complaining of appetite loss. A diagnosis of latent pernicious anemia was made by the findings of hemogram, myelogram and Schilling test.

　X-ray and endoscopic examinations revealed type IIa early cancer at the greater curvature. Serum gastrin level was high (1480 pg/ml). Partial gastrectomy was perfomed.

　Histological findings of the resected specimen were as follows:)

　1) Type IIa early gastric cancer (sm) at the greater curvature of the angle (3.0×1.5 cm).

　2) Type IIc early gastric cancer (m) at the lesser curvature of the antrum (0.5×0.4 cm).

　3) In fundic area, the mucosa was markedly atrophic, and normal parietal cells could not be found. Intestinal metaplasia was seen predominantly in fundic area, and was sporadic in others.

　It is known that pernicious anemia is highly coexistent with gastric cancer and characterized by hypergastrinemia and severe atrophy of fundic mucosa without normal parietal cell.

　So in pernicious anemia, gastric punch biopsy is necessary for examination of mostly diagnostic reversed type atrophic gastritis and associated gastric cancer.