2年8カ月前に多発潰瘍と診断されていたスキルス胃癌

Scirrhous Carcinoma of the Stomach Revealing Multiple Ulcers for Two Years and Eight Months

　胃の多発潰瘍として治療し，経過を観察していたところ，初回検査から2年8カ月後のX線検査でスキルス胃癌と診断された症例を供覧し，初回のX線および内視鏡検査所見をretrospectiveに検討して報告する．

　症　例

　患　者：枝○道○，52歳（初診時），男，博多織工．

　1974年6月11日朝，突然，洗面器1杯の吐血を来し，当院へ緊急入院した．

　A 52 year-old man was first admitted to the hospital because of acute hematemesis on June 11, 1974. X-ray examination of upper G. I. tract performed the next day showed a small niche on the posterior wall of the gastric corpus (Fig. 1, 2). On June 14, gastroendoscopy was performed to reveal an ulcerative lesion on the anterior wall and two ulcerative lesions on the posterior wall of the corpus (Fig. 3). Monthly repeated x-ray examinations and gastroendoscopy showed a healing ulcer on the posterior wall of the corpus (Fig. 4, 5). The patient was discharged on July 7, 1974. X-ray examinations performed on November. 1974 and September, 1975 showed n o abnormal findings.

　X-ray examination performed on February 18, 1977 revealed the finding of a leather bottle stomach (Fig. 6) and gastroendoscopy showed findings of scirrhus (Fig. 7). Repeated endoscopic gastric biopsy showed findings of Group IV. The patient underwent total gastrectomy on May 6, 1977 (Fig. 8). Pathological examination of resected stomach showed the lesion to be mainly a well-differentiated tubular adenocarcinoma which partly shows a scirrhous pattern with fibrosis in the deeper tissue (Fig. 9). It was infiltrating into serosa focally. Peritoneal dissemination in Douglas' cavity was noted. Regional lymph node metastasis (n₁) were found. The patient survived for 17 months after surgery by anticancer chemotherapy. Retrospective study of previous x-ray findings suggested possibility of carcinoma (Fig. 2, 4). Although these lesions seemed to be primarily carcinoma, it had never shown any significant alteration for a long term. It was interesting that although the lesion was located in the corpus and showed leather bottle shape, a scirrhus, the histologic finding showed well-differentiated type.