全消化管にポリポーシス様の転移を来した胃印環細胞癌の1例

Metastases from Gastric Carcinoma to Esophagus, Duodenum and Large Intestine in the Form of Polyposis, Report of a Case

要旨　患者は69歳，男性．腹部膨満感を主訴に来院し，CEA高値を示した．全大腸に頂部にびらんを有し，立ち上がりが急峻なおよそ100個の3～8mm大のポリポーシス様病変を見い出し，食道，十二指腸にも同じような形態の多発病変を認めた．胃には体部，幽門部に同様の多発病変を認めた以外に，噴門部に3型進行癌が存在した．肺，肝などには転移はみられなかった．食道，大腸の病変からの生検で胃腸複合型粘液形質を持つ印環細胞癌と診断され，胃噴門部の印環細胞癌原発巣からの特異なリンパ行性全消化管転移と考えられた．

　A 69-year-old man with abdominal distention was admitted to our hospital. His serum CEA level was elevated. X-ray and endoscopic examinations revealed about one hundred small polypi throughout the entire large intestine. The polypoid lesions with clear margin were 3～8 mm in diameter and had erosions on the tops. Biopsy specimens from these polypi histologically demonstrated signet ring cell carcinoma with gastrointestinal mixed phenotype. Upper gastrointestinal examination showed not only multiple similar polypi in the esophagus, stomach and duodenal bulbus but also advanced carcinoma in the cardia of the stomach. No metastatic lesions were found in the lung and liver with CT scan. We concluded that this was a rare case in which gastric signet ring cell carcinoma had metastasized to esophagus, duodenum and large intestine in the form of polyposis.