6カ月間経過観察されたlinitis plastica型胃癌

Linitis Plastica Carcinoma of the Stomach, Report of a Case

　原発巣と考えられる陥凹性病変が初回検査時より認められたが，生検陰性であったため，結果的に約6カ月間の経過が観察されたlinitis plastica型癌症例を提示する．

　症　例

　患　者：57歳，女，地方公務員．

　主　訴：空腹時心窩部痛．

　既往歴：14歳時，急性糸球体腎炎に罹患．

　現病歴：1975年6月ころから空腹時心窩部痛および背部への放散痛出現，近医受診し，胃炎と診断され，内服薬の投与を受けるが軽快せず．1975年9月他医受診し，胃X線検査を受け，胃潰瘍と診断され，精査のため当院受診．なお1975年6月から来院までの4カ月間に約4kgの体重減少がみられた．

　We here present a patient with linitis plastica carcinoma who was suspected to harbor cancer by the first radiographic and endoscopic examinations of the stomach although biopsies twice performed showed no cancer and, therefore, she was observed for 6 months.

　The patient was a 57 year-old woman. She felt epigastric pain in the hungry time since about June 1975 and visited our hospital in October 1975, for scrutiny. The gastric x-ray films on October 4, 1975, revealed depressed lesions in the lower portion of the body and in the angle, but the body extended well. In the first endoscopic examination on October 6, 1975, there were two depressed lesions on the anterior wall side of the lesser curvature of the lower portion of the body and on the posterior wall of the angle and rugal hypertrophy in the body, suggesting linitis plastica carcinoma. When biopsies were performed twice on October 25 and November 4, 1975, cancers were negative in the samples from the margins of the depressed lesions.

　Endoscopic examination on February 20, 1976, unveiled malignant signs on the margin of the lesion in the lower portion of the body. Then biopsies from the above and angle portion on March 4 proved a signet-ring cell carcinoma and the patient underwent operation on April 7. As a result, it was found that the cancer was linitis plastica carcinoma infiltrating extensively, centering in the body portion and the cancer cells exposed to the superficial layer of the lamina propria mucosae only on the margin of the ulcerative lesion in the lower portion of the body, while in the other ulcerative scar portion cancer infiltration was proved in the deep layer of the lamina propria mucosae.