短期間に著明に増大した隆起性胃癌

A Case of Protruding Type of Gastric Cancer Grown up within a Short Time

症例

　患　者：野○竹○，74歳，男性．

　主　訴：心窩部鈍痛．

　既往歴：54歳，肺結核．

　病　歴：昭和47年4月初め，めまい，耳鳴りのため，近医受診動脈硬化症として投薬を受けたところ，心窩部に鈍痛を感じるようになり胃精査を希望して4月10日当院初診受診した．胃X線検査，胃内視鏡検査，生検にてⅠ型早期癌と診断，手術することをすすめたが本人が頑強に拒否し，繰返し説得し3カ月後の9月12日に入院し，9月21日胃切除術を施行した．

　X-ray examination of the stomach in a man 74 years old revealed a protruding lesion, 2 cm in the greatest diameter, in the lower part of the corpus on the posterior wall. Type I early cancer was suspected by gastrocamera study. Biopsy under direct vision confirmed it as papillary adenocarcinoma. Nevertheless, as the patient flatly turned down any surgical intervention, we had to follow up the lesion for another three months without any active measure. In the interim both x-ray and endoscopy revealed rapid growth of the tumor, showing a pattern of advanced carcinoma of Borrmann type Ⅰ. He gave way.

　Excised specimen showed a semi-pedunclated, spherical cancer tumor, 3.2 by 3.5 cm, encircled partly by a plateau-like elevation of irregular shape, looking like a Ⅱa lesion. The depth of invasion was pm, highly involving the lymph vessels. Doubling time of the tumor as was measured on the x-ray film was 234 days.

　Study of protruding types of gastric cancer we were able to follow up retrospectively for more than six months shows that, though not all, four cases permitted us to measure doubling time of the tumor growth. They were all of early cancer at the time of surgical intervention, the doubling time ranging from 484 to 1,228 days.

　Many factors are involved in the speed of cancer growth. Sometimes they grow up very slowly, and sometimes they increase in size very rapidly as was exemplified in the present case.