定例検査の78日後に変貌せるスキルス

Scirrhous Carcinoma Showing Marked Radiographic Changes over a Short Period

　われわれは20年来，胃癌早期発見を主たる目的とする登録制定期成人病検診を続けているが，本例はその間ただ一度遭遇せるスキルスである．ちなみに，現在総登録数は800名．発見胃癌は，本例を除き，進行癌4例（いずれも初回），pm癌4例，早期癌22例である．

　症　例

　患　者：61歳，男，会計士．

　既往症：30歳に腸チフス．

　嗜好品：1目たばこ25本，日本酒2合．

　検診登録の動機：いとこが初回検査で進行胃癌を発見され再発死せるため，定期検診の必要性を認めた．

　初診時所見：1963年3月，50歳，体重43kg（標準60.9kg）．胃X線検査所見は軽度胃下垂．その他特記すべきことなし．その後，極めて几帳面に，半年に1回ずつ受診を反復していた．

　The patient was a 61 year-old male with a complaint of epigastric fullness after meal. For the past 11 years he had undergone medical check-up regularly twice a year. These examinations indicated twice the irregularity of relief of the gastric body and he was recommended further evaluation.

　The initial examination revealed no remarkable findings except widespread atrophic gastritis in 1970. The next examination, two years after the first one, showed healing stage of erosion on the lesser curvature of the middle body and antrum. In 1974, the last regular examination was performed with no symptoms and x-ray films disclosed atrophic gastritis. But after 78 days, the patient visited us with complaint of increasing epigastric fullness for one month. At this time x-ray and endoscopic examinations revealed narrowing of the gastric body and scirrhus was diagnosed. Total gastrectomy was performed and operative findings were S₂H₀P₀.

　Histological diagnosis was poorly differentiated adenocarcinoma. This scirrhous carcinoma seemed to grow rapidly on the x-ray films and retrospective observation exhibit no clear primary focus.