Borrmann 4型胃癌（スキルス）の経過観察例―粗大皺襞がスキルスを疑わせた例

Scirrhous Carcinoma of the Stomach: Report of a clinically followed-up case with giant folds

　従来よりBorrmann 4型胃癌（特にscirrhus）を早期診断することは困難であったが，われわれは手術1年前にX線，内視鏡検査を施行したが確診を得られなかった，粗大雛襲を認める症例を経験したので報告する．

　症　例

　患　者：54歳，男，公務員．

　主　訴：空腹時上腹部痛．

　家族歴：長兄は胃癌にて死亡（45歳），次兄も胃癌にて死亡（50歳）．

　既往歴：左肺結核にて胸廓成形術（28歳時），高血圧症治療中．

　現病歴：1972年胃集検にて要精検，千葉大学第1内科にてX線，内視鏡，生検施行したが異常なし．

　1973年胃集検にて要精検，6月当センターにてX線にてポリープ疑および胃体部の粗大殿漿を指摘，胃カメラ施行ではポリープおよび粗大雛襲にて6カ月後経過検査を指示する．

　It has been difficult to make an early diagnosis of scirrhous carcinoma of the stomach. This paper presents a clinically followed-up case for two years with repeated G-Ⅰ study.

　A 54 year-old male underwent gastrectomy for scirrhous carcinoma. Twice, G-Ⅰ study was performed, two years and one year before the operation. Previous G-Ⅰ studies revealed only giant mucosal folds and a polyp at the corpus, and histological examination of the biopsy specimens revealed benign findings. The final G-Ⅰ study disclosed typical findings of scirrhous carcinoma of the stomach. Endoscopic biopsies showed poorly differentiated adenocarcinoma only in the ulcerated portions, but did not reveal any malignant findings in the giant folds. Histological examination of the resected specimen showed that carcinoma was exposed at the ulcerated area and that carcinomatous infiltration runs beneath the giant folds.

　It is widely known that occasionally, biopsy of giant folds is not diagnostic, but the necessity of careful follow-up of the patient is emphasized.