短期間に著明な形態変化を来した胃癌の1例

Gastric Cancer that Underwent a Rapid and Drastic Morphological Change, Report of a Case

要旨●患者は80歳代，男性．吐血を主訴に救急搬送．上部消化管内視鏡検査で前庭部大彎に周堤様の隆起を伴う平皿状の類円形潰瘍性病変を認めた．第4病日の再検では潰瘍底に深い溝状陥凹を認めた．生検でGroup 5（por2〜tub2）の診断となった．第15病日に右膝窩動脈の急性動脈閉塞症を認め治療を行った．第38病日の内視鏡検査では隆起性病変に変化していた．第58病日に幽門側胃切除術を施行．病理診断はType 5，リンパ球浸潤癌，pT1b2，ly1，v0，pN0であった．リンパ球浸潤癌が線維化に乏しく軟らかい腫瘍であったため，外力により病変が内腔側に折れ曲がり隆起型へ変化したものと思われた．

　An 81-year-old man was admitted to our hospital because of hematemesis. Endoscopic examination showed a round and flat ulcerative lesion with sharp raised margins, which was almost circumferential in the greater curvature of the antrum. On the fourth day of hospitalization, endoscopic re-examination revealed that the lesion had bended. Biopsy specimens from this lesion were histologically diagnosed as poorly- to moderately-differentiated tubular adenocarcinoma. On the 15th day of hospitalization, the patient was diagnosed with acute arterial thrombosis of the right popliteal artery, which required catheter treatment. After 38 days, endoscopic re-examination revealed that the lesion had changed to a polypoid lesion. Computed tomography found no distant metastasis. Distal gastrectomy was performed on the 58th day of hospitalization. Histopathological findings revealed Type 5 gastric carcinoma with lymphoid stroma（GCLS）, pT1b2（SM2）, med, ly1, v0, with no metastasis to the lymph node. Because GCLS has little fibrosis and is malleable to an extent, it was possible to bend the tumor toward the inside of the stomach ; thus, this drastic morphological change occurred.