3年6ヵ月前に施行した胃切開部に存在したⅡc型早期胃癌の1例

A Case of Ⅱc Type Early Gastric Cancer Found at the Previous Site of Incision Done Three and a Half Years Before

1．症例

　患者：K. N.　58歳　男

　主訴：心窩部痛

　家族歴：兄が胃癌で死亡

　既往歴：約8年前より高血圧症

　現病歴：昭和41年1月頃心窩部痛を覚え，某医を訪れ，しばらく投薬を続けたが改善をみず，同年2月某病院を紹介され，胃潰瘍の診断のもとに手術をうけたが，胃切開の結果，病巣が認められないということでそのまま切開部をとじただけであった．その後投薬を続け，経過は良好であった．42年2月頃再び心窩部痛を覚え，某医にて投薬を続け症状の改善をみた．44年7月頃より再三心窩部痛を覚え，44年8月当科を受診した．

　The present paper deals with a case of Ⅱc+Ⅲ type early gastric cancer found at the previous site of surgical exploration performed about three and a half years ago.

　The patient, a 58-year-old male, underwent gastric surgery under the diagnosis of gastric ulcer. However, when the stomach was opened no lesion was recognized so that the exploratory incision was closed again as it was. Since then he had frequent bouts of epigastralgia.

　X-ray and endoscopy examinations done three and a half years after the initial surgery led the authors to the diagnosis of Ⅱc+Ⅲ type early cancer on the anterior wall of the antrum with its adjacent adhesion and ulcer (upper corpus, Ul-Ⅳ²). Endoscopy also revealed a linear groove-like depression on the anterior wall of the antrum, passing through the lesion in parallel with both curvatures. This was considered to be the previous incision scar. Gross appearance of the resected specimen presented the same findings as well. Histologically, it was adenocarcinoma papillotubulare with sm degree of depth invasion, U1-Ⅲ³. A rest of silk sutures was recognized within it.

　Both roentgenologically and endoscopically it was rather difficult to locate the lesion. In addition, the lesion looked at a first glance as if the whole of it was protruded. This perplexing finding was probably due to the fact that the lesion was located within the site of the incision with incidental adhesion. Further investigation seems necessary for its correct diangnosis. Long duration of the retrospective follow-up study in this case set against considerations of the literature of gastric stump cancer together with histological findings seems to indicate that cancer presumably did not originate after the surgery; early cancer had been there already before the operation and it was quite incidental that the dormant lesion was incised.