妊娠中に持続する悪阻症状で発見された進行胃癌症例

Gastric Carcinoma Diagnosed due to Vomiting and Weight Loss during Pregnancy

要旨　患者は25歳，女性．妊娠初期から心窩部不快感があり，嘔吐と体重減少を伴うようになったため，上部消化管内視鏡検査を施行した．前庭部に狭窄があり，一部潰瘍を伴っていた．生検で印環細胞癌を含む低分化腺癌を認め，4型胃癌と診断した．CT検査では前庭部に全周性の腫瘍と幽門上リンパ節腫大を認めた．全身状態が安定した後に手術を行った．腹膜播種を認めたが，幽門狭窄を来していたため幽門側胃切除術を施行した．妊娠中に胃癌を合併する頻度は非常に低く，発見時には大半は進行している．妊娠中の胃癌に対する化学療法の報告は少なく，他臓器癌の報告を参考にして化学療法を施行した．休薬期間に合わせて妊娠37週に出産し，児は低出生体重児であったが，呼吸循環動態や骨髄抑制を含めた採血異常は認められなかった．分娩後2週間後に化学療法を再開する．

　A 24-year-old, G3/P2 pregnant woman at 24 weeks of gestation, underwent gastrofiberscopy, due to vomiting and weight loss. Symptoms began at the end of the first trimester and continued throughout the second trimester. Endoscopic observation revealed a gastric carcinoma with pyloric stenosis and considerable residue. Histology of the tumor showed poorly differentiated adenocarcinoma with signet-ring cell morphology, and CT indicated a stomach tumor with lymph node metastasis. Under the diagnosis of advanced gastric carcinoma, a distal gastrectomy was performed. The patient showed peritoneal dissemination and the disease was ultimately classified as Stage IV. After surgery, S-1 and paclitaxel chemotherapy was administered from the third trimester. Gastric cancer associated with pregnancy is quite rare and is not usually diagnosed until the disease is at an advanced stage. Reports concerning treatment during pregnancy are scarce, but there are some reports that chemotherapy can be safely administered to a patient and her unborn child during the second and third trimesters of pregnancy. Heeding these reports, we administered chemotherapy after surgery from the third trimester. She was underwent vaginal delivery at 37 weeks of gestation without any disorder of her baby.