重複早期胃癌の1例

A Case of Double Early Gastric Cancer

　われわれは胃X線所見および胃内視鏡所見から多発性胃癌を疑い，切除標本の組織検索により2コのⅡc型の重複早期胃癌と判明した症例を報告する．

症例

　患　者：佐○孝○郎，45歳，農夫．

　主　訴：心窩部不快感．

　家族歴：母が子宮癌，兄が肺癌で死亡している．

　既往歴：昭和32年，黄疸あり，肝炎として入院加療をうけたことがある．

　Case : a farmer 45 years of age. Complaining of unpleasant sensation in the upper abdomen, he came to our hospital on November 28, 1970. At the x-ray examination in the out-patient's clinic, rigidity of the gastric wall in the upper body was noticed together with rough mucosal patterns in the antrum. Endoscopy revealed white coat of irregular shape in the upper body with mucosal convergency. One and a half month after admission, the white coat seemed to have diminished very much as seen by endoscopy, and at a glance the lesion suggested diminution in size. However, because of irregular engorgement and swelling of the area where the white coat had adhered, in addition to abnormal course of mucosal reliefs, we suspected a Ⅱc type early cancer. The other lesion in the antrum remained uncertain by endoscopy, but x-ray taken before the operation disclosed a depressed lesion here as well. Gastric juice showed hypoacidity by Gastrotest.

　On March 25, 1971, subtotal gastrectomy was performed. Depressed lesions were seen in both on the anterior wall of the upper body and on the posterior wall of the antrum. The former was adenocarcinoma microtubulare mucocellulare, CAT Ⅲ, SAT 3, Ⅱc＋Ⅲs, showing a malignant cycle. The latter was adenocarcinoma tubulare mucocellulonodulare, CAT Ⅲ, SAT 3, Ⅱc＋Ⅲ. Though slightly varied histologically, they were double early gastric cancers, essentially of the same type of undifferentiated adenocarcinoma.