潰瘍瘢痕の長期経過観察中に確認された早期胃癌の1例

Abstract

A 72-year-old male, who complained of hematemesis, was referred a near hospital in August 1991. He was endoscopically diagnosed as kissing-type bleeding ulcer at the gastric angulus, and he recieved conservative treatment. The ulcer changed to the scar for a month. The histological diagnosis of the biopsied specimen was compatible with Group II. After three months, the ulcer changed to a small reddish elevated granulomatous lesion with fold concentrations around the ulcer scar. He was followed up by endoscope and biopsy at once in three months for two years. The lesion enlarged slowly, and in March 1994, the histological diagnosis of the biopsied specimen was compatible with Group IV. In April, the lesion changed to a multiple elevated lesion with fold concentrations and a central depression. The histological diagnosis of the biopsied specimen was compatible with Group V. The lesion was diagnosed as 0'IIa＋IIc, type of gastric cancer. Distal gastrectomy, Billroth-I reconstruction and D2 lymph node dissection was performed. Histopathological diagnosis of the lesion was 0IIa＋IIc, tub1, sm, Ul-IVs, n0, ly0, v0. Although ulcer was recovered, cancer was undeniable and we confirm again the importance of periodical endoscopic examination for gastric ulcer scar.