残胃吻合部に多発した早期胃癌の1例

Multiple Early Gastric Cancers, Type Ⅱa and Type Ⅱc of the Stoma in the Gastric Remnant, Report of a Case

要旨　患者は65歳，男性．33歳時，胃潰瘍で胃切除（Billroth Ⅱ法）あり．食欲不振でX線検査と内視鏡検査を受け，残胃吻合部の多発早期胃癌と診断され手術した．手術標本では吻合部に接して，前後壁に発赤の強い，表面が結節状のイモ虫様隆起を認め，これら2つの隆起に挟まれた小彎に境界不鮮明の褪色した浅い陥凹を認めた．組織所見では前壁は3.0×1.5cm，後壁は1.5×1.5cm，いずれもm，高分化型のⅡaで，その粘膜下層には囊胞状に拡張した腺管を認めた．陥凹は3.0×1.5cm，m，未分化型のIlc型であった．これら癌周囲の背景粘膜をみると，固有腺は軽度の萎縮を認めるもののほぼ保たれていたが，腸上皮化生は癌巣周囲を含む吻合部付近には認められなかった．

　A 65-year-old man was admitted to our hospital complaining of loss of appetite in January 1981. In 1949, he had partial gastric resection with side to end anastomosis (Billroth Ⅱ) for gastric ulcer. X-ray and endoscopic examination revealed two polypoid lesions and a depressed lesion in the area of the anastomosis. On the resected specimen, the two polypoid lesions proved to be Ⅱa type of early carcinomas, well differentiated adenocarcinoma with the size of 30mm×15mm and 15mmX15mm respectively, and the depressed lesion was a Ⅱc type of early cancer, mucocellular adenocarcinoma 30mm×15mm in size. These stomal carcinomas limited to the mucosa coexisted with stomal gastritis. In the area of stomal gastritis around the cancers, hyperplastic foveolar epithelium, cystic dilatation of mucosal and submucosal glands and slight atrophy of the gastric glands were noted without intestinal metaplasia.