悪性サイクルを示し天庖瘡と合併した胃癌症例

A Case of Gastric Cancer with a “Life Cycle of Malignant Ulcer” Associated with Pemphigus Vulgaris

　内臓の悪性腫瘍に諸種皮膚疾患が合併することは以前から時々報告されており，悪性腫瘍の存在をある程度推定しうるともいわれている．われわれは胃の巨大潰瘍が約1カ月後著明縮小した時，Ⅱc様変化が著明となり悪性サイクル¹⁾の一面を把えたと判断したと時を同じくして，偶然にも水疱性皮疹が出現し一種の天疱瘡と診断された症例を経験し，両者の経過を詳細に観察しえたので報告する．

症例

　患　者：鍛○屋○枝，58歳，女．

　主　訴：心窩部痛．

　既往症：以前より胃弱，3～4年前胃下垂症を指摘．2年前より癌痒性水疱性紅斑が出没していたが初診時には消失している．

　A 58-year-old female underwent radiologic and endoscopic examinations because of epigastric pain. A giant ulcer was found at the body of the stomach. One month later, the ulcer had almost disappeared leaving in its wake a II c lesion that became more distinct, when itching and vesicular erythema, or pemphigus vulgaris, appeared all over the body. Biopsy specimens obtained from the gastric lesion confirmed it as malignant. However, gastrectomy was not performed until pemphigus became better with corticosteroid treatment. The ulcer was found enlarged again at the time of operation.

　Histologic examination of the resected stomach revealed tubular adenocarcinoma of type Ⅱc surrounding the ulcer, a Ul-Ⅳ. Carcinomatous infiltration remained mostly within the mucous membrane, but it partly penetrated even into the muscle layer. This case seems to exemplify “the life cycle of malignant ulcer,” for benign gastric ulcer was first suspected when the lesion was so large. Of particular interest is a complication of pemphigus in gastric cancer. Cases of malignant disease in visceral organs associated with pemphigi (particularly dermatitis herpeticormis Duhring) have occasionally been reported in detail. Exact relationship between two diseases seems to remain still unclarified, but there are several reports describing that removal of a tumor results in remission of the exanthema. Although glucocorticoid had been the only effective agent before operation for the skin lesion of the present case, it did not get worse after operation without any drug. She has been in good condition during one year after the operation, being treated at our clinic with only small maintenance dose of glucocorticoid for slight exanthema on the trunk.