急速な進展を示したスキルス型胃癌の1例

Scirrhous Carcinoma of the Stomach Showing Rapid Growth, Report of a Case

　X線ならびに内視鏡検査では悪性とする所見が認められなかったのに，1年後の検査では既に進行胃癌で癌性腹膜炎を伴っていた症例を経験したので報告し，一，二考察を加える．

　A 53 year-old man suffering from epigastric discomfort and poor appetite visited our clinic.

　An upper gastrointestinal series was unremarkable and gastrocamera examination revealed atrophic gastritis without findings suggesting malignancy. Approximately one year after the first visit, he again visited our clinic with the complaints of urination-trouble, full sensation of the lower abdomen, constipation and lumbago.

　The second upper gastrointestinal series showed rigidity of the greater and lesser curvatures, and filling defects at the angulus and in the greater curvature of the lower body of the stomach.

　The second gastrocamera examination done one year later revealed thickening and rigidity of the gastric mucosa, and irregularly nodular, swollen mucosal folds partially with small masses on the anterior and posterior walls, and the greater curvature in the mid-and lower body. An irregularly shaped, shallow ulcer was also visualized on the lesser curvature of the lower body of the stomach. A diagnosis of gastric carcinoma of Borrmann type Ⅳ was made.

　Gastric biopsy under direct vision demonstrated adenocarcinoma tissue with a number of signet-ring cells.

　Operation could not be performed because of peritoneal carcinomatosis with ascites. He died 4 months after his admission, despite chemotherapy.

　Two sisters of his were also affected with gastric carcinoma nearly at the same time.

　The one had an inoperable gastric cancer of Borrmann type Ⅳ associated with carcinomatous peritonitis, and the other had an early gastric cancer of type Ⅱc which was successfully treated surgically. Histologically those lesions demonstrated adenocarcinoma with signet-ring cells as was also the case with their brother.