多発性陥凹性早期胃癌の1例

A Case of Multiple Depressed Early Gastric Cancers (Quadruple Cancers)

症例

　患者：56歳，男

　主訴：食後1～2時間しての上腹部痛

　家族歴：特記すべきことがない．

　既往歴：43歳，肺結核，酒，餅が好き．

　現病歴：昭和43年2月，食後上腹部痛を認め，某医で胃潰瘍の診断を受け，1カ月位で軽快した．その後も時々服薬していた．昭和44年2月再び上腹部痛を認めるようになり，黒色の排便もあった．今度は胃角部潰瘍の診断で手術をすすめられ，昭和44年2月17日入院した．

　In Feb. 1969 a 56-year-old man was referred to the Fukui Prefectural Hospital because shortly before he had several episodes of tarry stool in addition to epigastralgia of one year's duration arising 1～2 hours postprandially. No significant abnormalities were found at admission both on physical and laboratory examinations. The gastric juice was of normal acidity.

　X-ray study of the stomach showed a large round ulcer at the gastric angle with a constriction of the greater curvature opposite it. Endoscopic examination also disclosed two round ulcers at the angle together with a lesion assumed to be Ⅱc type cancer in the greater curvature, although its details were obscure because of the photograph taken at too close a distance. Gastrectomy was accordingly carried out under the diagnosis of kissing ulcers at the angle and Ⅱc+Ⅲ type early cancer in the greater curvature.

　The gross specimen of the resected stomach showed four different lesions. A deep round ulcer (A, 13×10 mm) was seen at the angle with another round ulcer (B, 8×7 mm) located just anteriorly to it. There was still another Ⅱc+Ⅲ type lesion (C, 35×27 mm) on the posterior wall in the greater curvature side. The fourth was a slight depression (D, 10×9 mm) on the anterior wall of the antrum. Mucosal convergence around the ulcers A and Bwas relatively regular.

　Histologically, the lesion A was a Ul-Ⅳ type ulcer with submucosal cancer in the cardiac side of its margin. B was a Ⅲ+Ⅱc type cancer with its Ⅱc region restricted in a small area around a Ul-Ⅲ type ulcer. C was a Ⅱc+Ⅲ type early cancer with partial submucosal involvement, while D was a Ⅱc localized within the mucosa. All these lesions showed similar architecture, belonging to tubular adenocarcinoma.

　Endoscopy alone was insufficient to diagnose the type Ⅲ and Ⅲ+Ⅱc lesions at the gastric angle, but the lesion D, a Ⅱc on the anterior wall, was discernible.

　The present case decidedly indicates the necessity of gastric biopsy. The development of four different types of depressive early cancer in the same stomach also furnishes us with a very interesting problem about its histiopathogenesis.