著明な蛋白漏出を来たした絨毛状Ⅰ型早期胃癌

A Case of Ⅰ+Ⅱb Type Early Gastric Cancer with Remarkable Protein Loss

　消化管より著明な蛋白漏出を示し，術前Borrmann Ⅰ型進行癌と診断，手術により広範なⅠ＋Ⅱb型早期胃癌で，しかもⅠ型の部分は見事な絨毛状発育を呈した興味ある症例を経験したので報告する．

　The case of a 78-year-old male is described here with longstanding edema on the face and lower extremities for 6 months, whose laboratory examinations showed Hb 68%, total serum protein 4.4 g/dl and increased I¹³¹ PVP excretion rate of 27.82% (normal range: less than 1.5%).

　Roentgenologic and endoscopic studies of the stomach revealed polypoid lesions in an area from the gastric angle down to pyloric antrum, which were suspected as advanced cancer.

　Endoscopic biopsy of gastric mucosa indicated adenocarcinoma tubulo-papillare.

　Resected stomach showed an area, each measuring 7×3cm, 4×2cm, 3×3cm, 3×2cm, 2×2cm, of polypoid lesions extending form the pyloric antrum up to gastric angle. A part of these polypoid tumors had an papillary or villous appearance which is often seen in large intestine.

　Histopathological diagnosis was a Ⅰ+Ⅱb early cancer of tubulo-papillare adenocarcinoma type, most of its infiltration limited within the submucosal layer.

　The plasma protein level of the patient was rapidly improved to normal range in two weeks after the gastrectomy.

　This fact suggests that the hypoproteinemia of this case might have been induced by the loss of protein from gastric mucosa of widespread Ⅰ+Ⅱb type early gastric cancer.