3年11ヵ月の逆追跡ができた胃体部のスキルスの1例

Retrospective Study of Scirrhous Cancer of the Gastric Body, Report of a Case: Traced as far back as three years and 11 months

　3年11カ月の逆追跡ができた胃体部の比較的限局したスキルスの1例を報告する．胃体部のスキルスの発育進展を考える上で，興味ある症例と考える．

　症　例

　患　者：F. A.　48歳，女．

　1973年10月，心窩部痛を主訴として，S病院を受診した．以来，胃癌と診断がつくまでに，X線検査6回，内視鏡検査7回，胃生検1回の検査歴がある．図表に制限があるので，内視鏡像の呈示は省略する．X線像は初回（1973年10月27日），5回目（1976年7月9目）および術前（1977年8月31日）のX線像を呈示する．

　The patient, a 48 year-old woman, was examined at a hospital because of precordial pain and was treated for more than two years and a half under a diagnosis of gastric ulcer before a final diagnosis of gastric cancer was made. It was a scirrhous cancer. She then underwent surgical intervention. Retrospective study of x-ray and endoscopic pictures shows us that it must have been cancer from the outset. All through the process of development of presumed ulcer, only 15 mm long, into a scirrhous cancer, measuring 55×60 mm, in the course of 3-year-11-month, ulcer was present in the center of the lesion later proved as cancer. The mucous membrane around the ulcer was seen in the first 2-year-8-month as gradually thickened tips of the converging folds. After 2-year-9-month, the thickened mucous membrane not only around the ulcer but in a region a little toward the anus was observed along with its abnormal runs. During the period from 2-year-9-month to 3-year-11-month, the gastric wall was hardened obviously.

　Histologically, cancer infiltration into the mucous membrane was limited in the periphery of the ulcer. Underneath the mucous membrane, there were signet ring cells with proliferating collagen fibers infiltrating down into the subserosal layer. At the advanced regions of cancer in the submucosal layer, cancer was infiltrating into the lymphatic vessels.

　The fact that cancer infiltration in this patient did not reach far down from the mucous membrane seems to be of another type from that of Nakamura et al's linitis plastica, but extension of cancer into the gastric wall which was not directly continued from ulcer periphery was the same as seen in linitis-plastica-type.

　Were it not for resection, cancer must have finally extended to the entire stomach and would have become gastric cancer of linitis-plastica-type.