胃ポリープで経過観察中進行胃癌を生じた1症例

A Case of Advanced Carcinoma of the Stomach Arising out of a Lesion Being Followed-up as Polyp

　胃癌の診断が確定して，しかも経過を追うことはまずきわめてまれである．かなりの期間にわたり経過をみて，しかも最終的に進行癌として手術された症例には，それぞれ事情があることは当然である．その主な原因は経過観察中における検査が不充分であったための見落しか，患者の都合で充分の検査が施行できなかったため経過中における癌の初期像を捉えることができなかったかのいずれかであろうかと思われる．

　われわれは当初2年にわたり多発胃ポリープの経過を観察していた症例が，患者の都合でその後当院における検査が施行できず，3年後に症状を訴えて来院したときに巨大な進行胃癌を発見した症例に遭遇したので報告する．

　The case here presented was diagnosed at the initial endoscopic examination as polyps, one located on the greater curvature of the antrum, and the other on the lesser curvature of the mid-body. It was followed up for as long as five years and two months, to be confirmed finally as advanced carcinoma of Borrmann type Ⅲ. Biopsy also done at the outset revealed them benign. There was no possible finding in the body to suggest cancer. Ensuing two examinations were non-contributory. It was noticiable that at the fourth examination by endoscopy (three years and three months before the surgical intervention) the small polyp in the mid-body was ill-defined; slight reddening, coating and rough mucosal surface were seen instead on the probably same location. Retrospectively, this minute change might have been cancer. As the patient did not visit us until the surgical correction, circumstances leading up to it were not clear.

　The resected stomach revealed a cancer lesion, measuring 6.0 by 6.5 cm. Though there had been a long blank before the operation, we assumed that cancer must have fairly rapidly increased in size.

　The relationship between polyp and cancer remained unclarified, but it is of great interest that at one time of cancer development polyp did become indistinct, a fact also reported by Furusawa et al.