胃原発絨毛癌の1例

A Case of Primary Choriocarcinoma of the Stomach

要旨　患者は64歳，男性．2008年8月より発熱，全身倦怠感が出現し，総胆管結石による胆管炎の診断のもと，内視鏡的乳頭括約筋切開術による加療中，胃に隆起性病変を認めた．再検査の生検で絨毛癌と診断され当院を受診した．画像診断で他臓器に原発巣や転移などを疑う所見はみられず，胃原発絨毛癌の診断のもと外科手術を施行した．病理組織診断では壁深達度pT3，小彎，大彎，脾門リンパ節でpN2の所見を認め，免疫組織化学的に腫瘍細胞はhCG陽性であった．術後，合併症などはみられず，現在に至るまで再発は認めない．

　A 64-year-old man was admitted to our hospital because of fever and general malaise. Generalized examination was carried out, and cholangitis due to a common bile duct stone was diagnosed. Medical therapy by endoscopic sphincterotomy was carried out and a protruded tumor lesion with surface hemorrhage and necrotic change was seen on the posterior wall of the upper body. Re-endoscopic examination with biopsy revealed a choriocarcinoma. The patient was admitted to our hospital for the purpose of close inspection and medical treatment and CT and PET-CT revealed no other primary tumor site nor organic metastasis. Gastrectomy and pancreas tail spleen complication ablation were performed. Histologically, the tumor cells mimicking cytotrophoblastic cells, syncytiotrophoblastic cells, and intermediate trophoblasts, revealed pT3, pN2. Immunohistochemically, the tumor cells were positive for hCG, hPL, CEA, CA19-9, PLAP, AE1/AE3, CAM5.2, CK7, CK19. The postsurgical clinical course was favorable and no relapse has been observed over the following 2 years.