残胃にみられた4型進行癌の1例

Type 4 Advanced Carcinoma of the Remnant Stomach, Report of a Case

患者　患者は79歳，男性．便秘を主訴に近医を受診した．上部消化管内視鏡検査で異常を指摘され精査目的で当院に入院となった．上部消化管内視鏡検査では残胃吻合部小彎，前壁に辺縁不整な潰瘍性病変がみられ，同部からの生検で低分化型腺癌と診断された．胃体上部から穹窿部にはひだの乱れがみられ一部に融合所見もみられた．胃X線検査では胃壁の伸展は比較的良好であるが，一部に粘膜の凹凸不整が目立ち，粘膜ひだに辺縁の不整像がみられた．残胃全摘術が施行された．残胃ほぼ全体を占める低分化型腺癌と診断された．腫瘍細胞は，吻合部小彎，穹窿部前壁の潰瘍性病変およびその周囲の粘膜に露出しているが，他の大部分では粘膜面に癌はみられず粘膜下層以深に癌は浸潤していた．残胃の検査の際にはその特異性を十分理解したうえで行う必要がある．

　A 79-year-old male was referred to our hospital complaining of constipation. Endoscopy revealed ulcerous lesions in the anastomotic site and upper part of the remnant stomach. Uneven gastric folds were remarkable in the upper body and fornix. Histological studies on biopsy specimens revealed a poorly differentiated adenocarcinoma. X-ray examination showed remarkably uneven mucosa and thickened gastric folds with irregular margins in the anterior wall of the remnant stomach. The distensibility of the gastric wall was relatively retained. Total gastrectomy of the remnant stomach was carried out. Pathological studies of the resected specimen revealed a poorly differentiated adenocarcinoma. Cancer cells were exposed in ulcerous lesions and the surrounding mucosa, but cancer cells had infiltrated submucosally into almost all of the remnant stomach wall. We should be conscious of such characteristics when we examine the remnant stomach and proceed with treatment accordingly.