胃角部接吻潰瘍の一方が早期癌であった1例

Early Gastric Carcinoma in One of Kissing Ulcers

　最近われわれは胃角部接吻潰瘍の一方（後壁側）が早期癌Ⅲ＋Ⅱcであり，他方（前壁側）が良性潰瘍でこれに線状潰瘍瘢痕が連なり，その一部に異型上皮がみられるという症例を経験したので，若干の文献的考察を加えてここに報告する．

症　例

　患　者：53歳　男性

　主　訴：空腹時心窩部痛

　家族歴・既往歴：特記すべきことなし

　A 53 year-old male was admitted to our hospital with complaint of hunger epigastric pain of two months' duration. Upper G-I series revealed two ulcerative lesinos on the both anterior and posterior walls at the gastric angle. The lesion on the anterior wall was diagnosed as benign ulcer, while the other on the posterior wall was interpreted as suspicious early gastric carcinoma. Endoscopic examination showed the findings corresponding that of X-ray examination: an ulcerative lesion suggesting early gastric carcinoma (type III＋IIc) on the posterior wall, and a benign ulcer accompanied with linear ulcerative scar on the anterior wall at the gastric angle. Biopsy specimens obtained from the lesion on the anterior wall were histologically negative for carcinoma. On the other hand, those specimens from the lesion on the posterior wall was adenocarcinoma tubulare. A partial gastrectomy with B-I method was undertaken.

　Histological examination of the removed specimen showed two ulcerative lesions in the pyloric gland region with severe intestinal metaplasia. The lesion of the posterior wall was III＋IIc type early gastric cancer (well differentiated tubular adenocarcinoma) with partial submucosal involvement. The other lesion of the anterior wall was confirmed to be benign ulcer accompanied by linear ulcerative scar, in which atypical epithelium suspecting borderline lesion be tween malignancy and benignity was seen.