スキルスの1症例

Scirrhus of the Stomach, a Case Report

　近年，早期胃癌の診断学が確立され，研究の焦点がより微細な早期のものに向かってきている．しかし一方では，前回の検査で異常を指摘できなかったにもかかわらず比較的短期間にスキルスに進行した症例の経験は今日なおあとをたたない．

　本症例は人間ドックに入り胃X線と内視鏡検査を受け，1カ月半後に胃集検を受診し，その7カ月後に中川医院によりスキルスと診断，国立札幌病院消化器科に入院，死亡，剖検した例である．

　A periodic health checkup of a man 48 years old on Sept. 1, 1970, revealed atrophic gastritis in both direct radiography and endoscopy. One and half a month later he underwent gastric mass screening with indirect roentgenography (6 exposures). The diagnosis was again atrophic gastritis and no advice was given him for further examination. In January 1971 he had a bout of severe abdominal pain followed by lasting loss of appetite. On April 1 his disorder was diagnosed as gastric scirrhus. On April 22 he was admitted to Sapporo National Hospital, where he died one month later from liver tumor and ascites. Diagnosis at necropsy was diffuse carcinoma of the stomach (centering on the anterior wall side of the lesser curvature of the body). Histologic diagnosis was adenocacinoma tubulare scirrhosum.

　The patient thus died 8 months and a half after the initial health checkup or 7 months after the mass screening. Even retrospectively investigated, no abnormality was to be seen in the roentgenograms (upright barium-filled, prone, double contrast and compression views) exposed at the first examination. Endoscopic pictures with GTF revealed on scrutiny mucosal convergency on the anterior wall side of the lesser curvature in the lower body. The adjacent rugae on the anterior wall were edematous and reddened. The mucosa on the posterior wall at the level of the angle was likewise swollen, discolored and losing tension. This finding might presumably be an endoscopic finding of scirrhus before becoming manifest in roentgenogram.

　It is highly regrettable that, despite extensive mural rigidity to be seen at the time of mass screening in upright and prone barium-filled pictures on the lesser curvature of the lower body, no pertinent advice was given him for detailed examination of the stomach.

　After all, early diagnosis of gastric scirrhus seemingly depends on the detection of small depressed lesions as a forerunner of Borrmann type Ⅳ of gastric carcinoma.