Bon ecarcinosisを合併し，短期間に急速な進展を示した胃びまん性癌の1例

Rapid Growing Diffuse Infiltrative Carcinoma of the Stomach with Bone Carcinosis

　患者：H. H.，50歳，男．

　現病歴：約3年前より心窩部の重苦しい感じを覚えることが時々あったが放置していた．1979年9月，初めて近医を受診し，慢性胃炎と診断され，治療を受けていた．しかし，体重の減少（6カ月で約10kgの減少）が気になり，同年11月当科を訪れた．外来時の胃X線および内視鏡検査で胃体部後壁にⅡcを思わす所見を認め，生検によりsignet ring cell carcinomaの組織像を得た．更に精査のため入院した．

　人院時現症：体格栄養中等度，貧血，黄疸なく，その他理学的に特に異常所見はみられなかった．

　A 50 year-old male with diffuse infiltrative carcinoma of the stomach with bone carcinosis was studied.

　A Ⅱc-like appearance in the posterior wall of the upper corpus was detected in the stomach region by the first endoscopic examination and a sudden and rapid growth of the region into a diffuse infiltrative carcinoma was observed by repeated examinations for four months. The biopsy from the IIc-like region and from the diffuse infiltrative carcinoma showed a signet ring cell carcinoma (sig.) of the stomach.

　The postoperative surgical and pathological diagnosis after a total gastrectomy with gastroesophagostomy was stage Ⅱ (P₀H₀S₀-1, N₁) and sig., se., ow (＋), aw (＋).

　Bone carcinosis was detected by elevated serum alkaline phosphatase of bone origin and bone scintigram showed high uptake figures by in almost all the bones except the skull. Ischial bone biopsy showed metastatic signet ring carcinoma.