高齢者で経過観察して進行胃癌になった1例

Early Gastric Cancer Progressed to Advanced Cancer in an Elderly Patient, Report of a Case

要旨●患者は80歳代，男性．右季肋部痛を主訴に近医を受診したところ，MRIで右第5，6肋骨に骨腫瘍を疑われた．精査の結果，多発性骨髄腫と診断された．上部消化管内視鏡検査で胃体下部小彎側に30mm大の陥凹性病変を認め，生検で胃癌と診断された．台状挙上所見陽性で，深達度はcT1bと診断した．多発性骨髄腫の治療を優先して行うこととなり，胃癌は無治療で経過観察の方針となった．病変は12か月後に50mm，16か月後に80mm程度まで増大し，噴門部から胃角部まで進展していた．陥凹内および辺縁隆起の厚みもさらに増しており，cT2以深と診断した．1年4か月で早期胃癌から進行胃癌に進展した症例を経験した．

　We report the case of a man in his 80s, with early gastric cancer that progressed to advanced gastric cancer within 16 months. Initially, magnetic resonance imaging revealed multiple bone tumors in his right fifth and sixth ribs. Following a bone marrow puncture, he was diagnosed with multiple myeloma. Esophagogastroduodenoscopy revealed a 30-mm depressed-type early gastric cancer at the lesser curvature of the lower gastric body. A biopsy specimen revealed a moderately differentiated tubular adenocarcinoma. Furthermore, the lesion was positive for the non-extension sign ; therefore, the invasion depth was diagnosed as cT1b. The treatment of multiple myeloma was prioritized, and the early gastric cancer was monitored without treatment. Twelve months later, the lesion was found to be 50mm in size, and at 16 months from the initial biopsy, the lesion was found to be 80mm in size, extending from the cardia to the angulus. The lesion had thickened, had a round wall, and was diagnosed as cT2 or deeper.