多中心性発生の微小癌巣からなるⅡa，Ⅱbの重複癌

Double Early Gastric Cancer of Type IIa and IIb with Multiple Ulcer, a Case Report

　多発性胃潰瘍を合併したⅡaとⅡbの重複癌を経験した．両癌巣は組織型を異にし，癌の存在様式も散在性，点状で癌の多中心性発生を示す興味ある所見を呈したので，臨床診断学的ならびに病理組織学的に若干の検討を加えて報告する．

症例

　患　者：H. K.　51歳　男性

　主　訴：心窩部痛

　家族歴：父が胃癌で死亡

　既往歴：16歳時虫垂切除術を受ける

　現病歴：4力月前より空腹時に心窩部痛があったが節食で軽快していた．2週間前から痛みが増強してきたので近医を受診した．胃透視，内視鏡検査の結果，胃潰瘍を指摘され精査の目的で当科を受診した．

　The patient, a 51-year-old man with a complaint of hunger epigastralgia, was referred to the author's hospital.

　X-ray and endoscopical study of the stomach showed a low polypoid lesion on the angle, which consisted of irregular nodules of various size and shape, and a benign ulcer with two ulcer-scars on the posterior wall of the middle body. The low polypoid lesion was suspected as a Ⅱa by X-ray and endoscopical pictures. Biopsy specimens obtained from this lesion led to a diagnosis of cancer.

　Histologic examination of the resected stomach revealed that the low polypoid lesion chiefly consisted of changes due to atrophic hyperplastic gastritis and the lesion was partially studded with minute foci of well differentiated adenocarcinoma. Apart from this, another independent multicentric foci of undifferentiated adenocarcinoma were shown in the flat mucosa around the polypoid lesion. The mucosa was almost occupied by the changes due to atrophic gastritis with intestinal metaplasia. And, a benign ulcer and two ulcer-scars were shown on the middle body.

　This case is interesting from the view point of the multicentric oncogenesis and histogenesis of gas-tric cancer.