生検陰性のスキルス胃癌の1例

Scirrhous Cancer without Identification of Cancer Cells on the Biopsy Specimens, Report of a Case

要旨　患者は38歳，男性．主訴は空腹時痛，体重減少．内視鏡検査で胃壁の伸展不良は軽度であるが，ひだの伸展不良と屈曲蛇行などの走行異常を認めた．原発巣とみられる陥凹性病変は認めず，びらんからの生検ではすべて陰性であった．X線検査でも同様の所見で収縮所見は軽度であったが，胃体部から穹窿部にかけてひだの密集と蛇行が観察された．CTでは胃体部全周に壁肥厚の所見を認めた．最終的にスキルス胃癌と診断し，胃全摘術を施行した．切除標本の病理検索ではひだの走行異常部分に一致し，広範に粘膜下層以深の浸潤を認めるスキルス胃癌（LP型）で，噴門前壁に8mmの原発巣を認めた．生検陰性であっても，ひだの走行異常などの画像所見に注目し，スキルス胃癌を診断することが重要と考えられた．

　A 38-year-old man was admitted to our hospital with complaints of hunger pain and weight loss for 3 months. On endoscopic and X-ray examination, thick and serpentine folds were recognized at the gastric body and fornix, but, on the other hand, the gastric wall stretched well under sufficient air pressure. Because of abnormal enlarged gastric folds, scirrhous type cancer was suspected, but the primary lesion could not be detected. Many biopsy specimens were taken from multiple erosions on the enlarged folds but cancer cells couldn’t be identified. The patient, macroscopically diagnosed as scirrhous cancer was operated on and the resected specimen revealed diffuse infiltration of the gastric wall, linitis plastica, and a tiny depressed primary lesion near the cardia.

　We concluded that the findings of abnormal gastric folds should have been considered scirrhous type of carcinoma even though there was no rigidity of the gastric wall that could be detected endoscopically and radiologically.