胃巨大皺襞症（Ménétrier病）に進行胃癌を合併した1例

A Case of Giant Rugae of the Stomach (Ménétrier's disease) associated with Advanced Cancer

　胃に巨大皺襞を認める疾患には良性のMénétrier's diseaseあるいはGiant hypertrophic gastritisといわれる巨大皺襞症と胃癌の浸潤による二次的な巨大皺襞を呈する疾患とがあるが，巨大皺襞症と胃癌とが合併した症例はきわめて稀である．

　著者らは最近，巨大皺襞症（Ménétrier病）と進行胃癌の合併例を経験したので報告する．

　A 54-year-old male who had been pointed out to have giant rugae of his stomach seven years previously, complained of epigastralgia of several months' duration. Roentgenographic examination revealed thick meandering folds of the body, narrowing and rigidity of the antrum with an excavated lesion on pressure film. On endoscopy, thick meandering mucosal folds from the cardia down to the angle were observed, but distensibility of the stomach was well preserved. Irregular shaped excavated lesion associated with dark clots was also observed on the posterior wall of the antrum.

　On laboratory examinations, serum protein was low (5.0 g/dl); feces gave positive occult blood (++～+++); GTT by administration of 50 g glucose was abnormal and gastric juice was normoacid.

　Gastric biopsy showed cancer in the tissue from the excavated lesion, and gastrectomy was performed. Resected stomach displayed abnormal thick mucosal folds resembling cerebral gyri extending from the fundus down to the angle. Adjacent to this, a tumor with uneven surface and partial depression, measuring 15×10 cm, was present involving the antrum. Histologic diagnosis of this lesion was mucinous adenocarcinoma medullare with abundant mucin production. Invation over the serosa was also recognized. Portions of the giant rugae consisted of extreme thickening of the mucosa and proliferations of the gastric glands up to several times as thick as the normal gastric mucosa. No cancer invasion into this lesion was found.

　Postoperatively, serum protein soon increased up to 6.5 g/dl.

　This appears to suggest protein loss from the preoperative stomach.

　This seems to be a very rare case of gastric cancer associated in Ménétrier's disease with hypoproteinemia.