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Stomach and Intestine(Tokyo) Volume 41, Issue 2 （February 2006）

胃と腸 41巻2号（2006年2月発行）

Japanese English

症例

同時性7多発低分化型胃癌の1例 Multiple Synchronous Poorly-differentiated Adenocarcinoma of the Stomach, Report of a Case 岡本泰幸 ¹ , 中村常哉 ² , 田近正洋 ² , 河合宏紀 ² , 澤木明 ¹ , 水野伸匡 ¹ , 高橋邦之 ¹ , 井坂利史 ¹ , 今岡大 ¹ , 井上宏之 ¹ , 青木雅俊 ¹ , 山雄健次 ¹ , 望月能成 ³ , 横井太紀雄 ⁴ Yasuyuki Okamoto ¹ , Tsuneya Nakamura ² , Masahiro Tajika ² , Hiroki Kawai ² , Akira Sawaki ¹ , Nobumasa Mizuno ¹ , Kuniyuki Takahashi ¹ , Toshifumi Isaka ¹ , Hiroshi Imaoka ¹ , Hiroyuki Inoue ¹ , Masatoshi Aoki ¹ , Kenji Yamao ¹ , Yoshinari Mochizuki ³ , Takio Yokoi ⁴ ¹愛知県がんセンター中央病院消化器内科 ²愛知県がんセンター中央病院内視鏡部 ³愛知県がんセンター中央病院消化器外科 ⁴愛知県がんセンター中央病院遺伝子病理診断部 ¹Department of Gastroenterology, Aichi Cancer Center Hospital ²Department of Endoscopy, Aichi Cancer Center Hospital ³Department of Gastroenterological Surgery, Aichi Cancer Center Hospital ⁴Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital キーワード：多発胃癌 , 低分化型 , 胃型 , 同時性多発胃癌 Keyword: 多発胃癌 , 低分化型 , 胃型 , 同時性多発胃癌 pp.259-268

発行日 2006年2月25日 Published Date 2006/2/25

DOI https://doi.org/10.11477/mf.1403100282

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要旨　患者は69歳，女性．上部消化管造影・内視鏡検査にて，胃前庭部前壁に1か所，胃角部後壁に1か所，胃体部大彎に3か所，胃底部前壁に1か所の深達度Mと考えられるIIc型早期胃癌を認め，胃体部大彎に深達度SMと考えられるIIc型早期胃癌を1か所認めた．生検診断はいずれも低分化腺癌で，同時性7多発早期胃癌と診断し胃全摘術を施行した．手術所見では術前同様早期癌との診断で根治度Aと判断された．切除標本の病理組織学的深達度は，胃角部後壁の病変と術前SMと考えた胃体部大彎の病変がmpでほかはsmであり，最終病理診断は，tub2～por2，mp，ly3，v1，INF-β，sci，n＋（＃1，＃2，＃3，＃4a＋4S，＃5，＃6，＃7，＃8A，＃9で陽性）でpT2N2M0のStage IIIaの同時性多発胃癌と診断された．

　A 69-year-old female, with the complaint of dark colored stool and in whom previous upper gastrointestinal endoscopy at another hospital had revealed a lesion of early gastric carcinoma, was referred to our hospital for further examination and treatment. Radiographic and endoscopic examination of the upper gastrointestinal tract revealed seven lesions of early gastric carcinoma. The first lesion (type IIc) was detected on the anterior wall of the lower body (L area), a second lesion of type IIc was detected on the posterior wall of the lower body. Four lesions of type IIc were detected on the greater curvature of the middle body area (M area), and the seventh lesion of type IIc also was detected in the upper body area. Biopsy of six lesions revealed poorly differentiated adenocarcinoma, so we diagnosed this case as multiple synchronous early gastric carcinomas with seven lesions, whose depth of invasion was thought to be limited to the mucosa in six lesions and to the submucosa in the seventh lesion. However, when total gastrectomy was performed, histological examination of the resected stomach revealed two lesions invading the proper muscular layer and the other lesions invading the submucosal layer. Histology also showed positive metastasis in all of the resected lymph nodes. In general, multiple synchronous gastric carcinomas have been reported to be well-differentiated adenocarcinoma in histology and at an early stage. This case is very interesting because it was proved histologically to be poorly-differentiated adenocarcinoma and clinically it resembled early gastric carcinoma.