急速な発育進展を示したBorrmann 4型胃癌の1例

Gastric Carcinoma Growing Rapidly of Borrmann 4-type, Report of a Case

　胃癌に対する診断，治療の著しい進歩にもかかわらず，Borrmann 4型あるいはスキルス型胃癌の予後は極めて悪い．ここに逆追跡しえたBorrmann 4型胃癌の1症例を呈示し，その早期診断について考察を加えてみたい．

　症　例

　患　者：69歳，女，無職．

　主　訴：左側腹痛，胸やけ，体重減少．

　家族歴，既往歴：特記すべきことなし．

　現病歴：1971年5月初めより食後の腹部不快感が出現し，約1カ月後当センターを受診，胃X線，胃内視鏡検査の結果，慢性胃炎の診断で薬物治療を受けて症状は軽快した．1972年5月同様症状が再現し，6月には上記主訴の出現をみた．同年7月，当センターを再受診して胃X線胃内視鏡検査の結果，Borrmann 4型胃癌の診断で8月14日入院した．

　A 69 year-old woman visited our hospital with complaint of abdominal discomfort one year before admission. The first upper gastrointestinal x-ray series and gastroscopic study demonstrated a chronic gastritis and drug therapy was performed.

　Secondly, she visited with complaints of left abdominal pain, heart burn and weight loss (2 kg/month). The second upper x-ray series and gastroscopic study demonstrated a gastric carcinoma of Borrmann 4-type, a leather bottle type and then she was admitted to the hospital. Laboratory examination revealed anemia with a level of 11.6 g/dl.

　Total gastrectomy with dissection of regional lymph nodes and resection of local mesocolon was performed because carcinoma was infiltrated to the mesocolon.

　After operation she recovered, but she died of peritoneal carcinosis, after 15 months. Surgical specimen revealed distensible and abnormally thick margin from esophagocardiac junction to the angle accompanied by a abnormally widening fold.

　Histologically, edematous mucosa and slight fibrosis accompanying cancer infiltration in the submucosa and proper muscle was recognized. And the histological type was scirrhous adenocarcinoma.

　Early clinical diagnosis of gastric carcinoma of Borrmann 4 or scirrhous type is difficult because this carcinoma is mostly infiltrated in the submucosal layer before the primary location of carcinoma shows mucosal change.

　Inquiring the former data, the first x-ray pictures show a slightly irregular fold on the greater curvature of the corpus and the first gastroscopic pictures show that it is slightly reddened and rough in the corpus. Minor change to a morbid state can be considered from these findings. Therefore, careful follow-up study is extremely important for these gastric lesions.