胃体部の微小胃癌から急速に進展したlinitis plastica型胃癌の1例

The Linitis Plastica Type Cancer of the Stomach Developing Rapidly from the Minute Cancers on the Gastric body, Report of a Case

症　例

患　者：60歳，男．

主　訴：心窩部痛．

家族歴：特記すべきことなし．

既往歴：3年前胃潰瘍，某医により2カ月間治療を受け軽快．

現病歴：1973年6月上旬より空腹時心窩部痛あり．1973年6月26日受診．

　60 y.o. male. Three years before he suffered from gastric ulcer and he became well after drug therapy. Since the beginning of June 1973, he complained of epigastralgia when hungry. The x-ray examination of the stomach was performed on 26th June 1973, and the double contrast method showed two minute erosions (2×1 mm and 1.5×5 mm) suggesting cancerous lesions on the posterior wall of the body. The gastroscopical specimens taken at the same time showed no marked abnormality. Biopsy was done and no cancer cells were observed. He was followed up.

　After one year and four months from the first x-ray examination, he complained of epigastralgia, anorexia and weight loss. On 6th November 1974, the x-ray examination of the stomach was performed, and the roentgenograms at that time showed a typical form of linitis plastica type of gastric cancer on the body. The gastroscopical finding showed the narrowing of the lumen of the body, discolored granular gastric areae on the mucosal surface and no marked ulcerative lesions. and no cancer cells were detected by biopsy.

　On 14th November 1974, he was operated upon. The total gastrectomy was performed. The gastric wall was markedly thickened without “giantrugae” and any ulcerative lesion. On the microscopical findings, cancer cells invaded the submucosa, muscularis propria and serosa diffusely, and on the posterior wall of the body cancer cells were observed on the surface of the mucosa.

　Histological diagnosis is adenocarcinoma tubulare mucocellulare scirrhosum (CAT Ⅲ, SAT B, INF γ, ow (+), aw (+), Ly 3, V 1, S 3, n: 5/14) of the stomach.

　Six months later, he died of peritonitis carcinomatosa.

　From the experience of this case, minute gastric cancer of the size less than 5 mm must be studied by radiological and endoscopical procedures taking into account the results of biopsy. Some types of linitis plastica type cancer of the stomach may develop from minute gastric cancer. Therefore, the diagnosis of minute gastric cancer is very important and must be studied eagerly furthermore in future for relieving the life of cancer patients.