胃に多発性病変（進行癌，早期癌，異型上皮）が存在した1症例

Multiple Lesions (Advanced and Early Cancers and Atypical Epithelium) of the Stomach, a Case Report

はじめに

　近年，胃疾患に対する診断技術の向上とともに，同一胃内に多発する病変についても術前に精確な診断が可能となってきた．筆者らは，胸痛を主訴として来院した患者の糞便潜血反応が陽性であったために，胃レ線，内視鏡検査を行なった結果，幽門前部から角上部にかけて3つの病変を認め，進行癌，早期癌，異型上皮の併存であった症例を経験したので若干の考察を加えて報告する．

　A 60-year-old man visited the authors' hospital complaining of chest pain. Although he was completely free from symptoms pertaining to the gastrointestinal tract, he underwent nevertheless both x-ray and endoscopy examinations because occult blood had been positive in the feces. Unexpectedly x-ray revealed three independent lesions. The first was located on the lesser curvature of the prepyloric antrum a little over to the anterior wall; the second lesion was situated on the greater curvature opposite to the gastric angle; and the third, on the anterior wall above the angle.

　Preoperative diagnoses of the three lesions were, advanced cancer of Borrmann type Ⅲ, early cancer of I type and either Ⅱa type early cancer or atypical epithelium, respectively.

　Histopathologically, the lesion 1 was adenocarcinoma tubulare, most of its infiltration spread deeply in the submucosal layer with partial encroachment on the muscular coat. The lesion 2 was also adenocarcinoma with its invasion localized within the submucosal layer. The lesion 3 was regarded as atypical epithelium. All the lesions were histologically located quite independently from one another.

　The present case, a coexistence of multiple cancers and ATP, is of a very rare occurrence among all the literature of gastric cancer, but when seen from the standpoint of coexistence of early and advanced gastric cancers, it is on the contrary a not infrequent case not only in its types, age of the patient, but also in its incidence and predilection sites. It is also of great interest from the view point of clinical diagnosis, because in addition to no subjective symptoms pertaining to the gastrointestinal tract, very grave lesions were completely hidden from the barium-filled x-ray picture.