巨大皺襞が目立ったBorrmann 4型胃癌の1例

Borrmann 4 Type Carcinoma of the Stomach with Conspicuous Giant Fold, Report of a Case

　巨大皺襞様所見および胃体下部前壁の発赤びらんが目立ち，原発巣と考えられる胃体中部後壁の潰瘍性病変が，初回内視鏡検査時には病変としてチェックできなかったBorrmann 4型胃癌症例を提示する．

　症　例

　患　者：64歳，男，会社役員．

　主　訴：空腹時心窩部痛．

　既往歴：15歳時虫垂炎手術．

　入院時現症および検査成績：身長156.5cm，体重53.5kg，体重減少は認められなかった．体格中等度，栄養良，貧血，黄疸なく，胸部理学的所見に異常なく，腹部は回盲部に手術瘢痕を認め，心窩部に軽度圧痛を認めたが腫瘤は触知しなかった．検査所見では特に異常なく，便潜血反応（±），胃液検査は無酸であった．

　This is a case of Borrmann 4 type carcinoma of the stomach in which a giant fold, redness and erosion were conspicuous and an ulcerative lesion, presumably the primary lesion, had been overlooked in the first endoscopic examination.

　The patient was a 64 year-old man who had noted epigastric pain at fasting time since around September 1977 and visited a nearby clinic for examination. A giant fold on the greater curvature of the gastric corpus was demonstrated by x-ray examination of the stomach there. The first endoscopy performed in November 1977 disclosed a giant fold localized relatively well to the greater curvature of the middle corpus. The endoscopic picture taken in the second examination in January 1978 showed the giant fold as well as redness and erosion on the anterior wall of the lower corpus and the posterior wall of the middle corpus. Biopsy of the tissue from the giant fold was negative. In the third endoscopy is September 1978, the giant fold of the corpus became more conspicuous, while a white coat appeared in the center of the reddened area on the anterior wall of the lower corpus, and an ulcerative lesion developed on the posterior wall of the middle corpus. As signet-ring cell carcinoma was demonstrated by biopsy of the tissues taken from the margins of the ulcerative lesion on the posterior wall of the middle corpus and from the reddened, eroded area of the anterior wall of the lower corpus, the lesion was diagnosed as Borrmann 4 type carcinoma of the stomach, and surgery was performed.

　Histopathological examination confirmed it to be Borrmann 4 type carcinoma of the stomach with the ulcerative change on the posterior wall of the corpus as the primary lesion and spreading diffusely over the corpus.