極めて短期間に急激な変化を示したlinitis plastica胃癌の1例

Linitis Plastica Carcinoma Making Rapid Progress in a Short Period

　筆者らはわずか5カ月間にⅡc→局所性巨大皺襞→linitis plastica癌へと急激な変化を来した1例を経験したので，その初期のX線，内視鏡所見をretrospectiveに再検討し，若干の考察を加える．

　症　例

　患　者：51歳，男，公務員．

　主　訴：腹部膨満感およびるいそう．

　家族歴，既往歴：特記することはない．

　現病歴とその診断経過：1974年7月ごろより食後の腹部膨満感と食思不振を認め，約2kgの体重減少を認めたため，同年10月25日新野外科胃腸科医院を訪れ，X線，内視鏡検査を受けた．このときの検査では，角上部前壁に陥凹性病変を見るも，癌の確認を得られず，経過を見た．同年12月6日に胃X線検査にて同様な所見を見たが放置され，翌1975年2月15日のX線検査にてBorrmann 4型の確診を得て手術のため入院した．3月6日に胃全剔が施行された．入院時の検査成績には異常を認めなかった．

　We experienced a case with linitis plastica carcinoma of the stomach making rapid progress only in five months. A 51 year-old man visited our hospital with complaints of epigastric fullness and loss of appetite of three months' duration. First examination of roentgenography (October 1974) showed a shallow depression of irregular shape at the lower body of the lesser curvature, associated with somewhat edematous and misty appearance around the neighboring mucosal surface of body. Endoscopic view at that time revealed a Ⅱc-like depressed area accompanied by multiple eroded spots and edematous unevenness around the surrounding fundic mucosa. The patient was treated for gastric ulcer with medications and with temporary improvement. Three months later roentgenography showed enormously enlarged and tortuous folds localized in mid-body and we decided to follow him up with a suspicion of malignancy. Soon he was lost to follow up.

　When he re-visited the hospital again after two months, his complaints grew worse than before and roentgenography revealed a shape of leather bottle which made it easy for us to interpret it as a typical linitis plastica carcinoma. In February 1975 total gastrectomy was done, and gross appearance showed the generalized thickened and hypertrophic rugae in the entire fundic gland area, which was irregular, rugged and somewhat edematous.

　Besides, a Ⅱc-like cancerous exposure was seen at the lesser curvature of lower body which was thought to be the primary site. Histologically poorly differentiated adenocarcinoma involved the entire stomach, associated with marked lymphatic permeation. Unfortunately the patient died of extensive peritoneal dissemination.

　We are always facing the difficulties in early diagnosis of linitis plastica carcinoma. Retrospective study of the workup in this case confirms the following facts. In the first place the formation of leather bottle stomach does not necessitate long term. Our case showed a rapid progress from Ⅱc-like cancerous lesion to linitis plastica during a short period of five months. In the second place first roentgenographic and endoscopic picture showed some abnormalities suggestive of earlier signs of linitis plastica such as edematous mucosa with unevenness, sporadic eroded mucosa with oozing in addition to a Ⅱc-like depressed lesion.