異時性三重複癌（上頸癌，早期胃癌，胆囊癌）の1例

A Case of Unsynchronous Primary Triple Carcinomas: Carcinoma of the maxilla, stomach (early stage) and gall-bladder

　同時期または，時期を異なるにせよ，ある個体において異なる臓器に悪性腫瘍が発生することはさほど多いものではないとされてきたが，近年各種診断法の進歩とともに発見率は向上しその報告は枚挙に暇がないほどになってきた．しかし今なお3つ以上の臓器に悪性腫瘍が共存することはかなり稀とされ，本邦において文献上1974年までに22例の報告をみるに過ぎない．最近筆者らは右上顎癌手術6年半後に1型早期胃癌を発見，術中胆囊癌の併存を知り，その後剖検し得た1例を経験したので，若干の考察を加えその概要を報告する．

　Recently we have experienced a patient with type I early gastric carcinoma discovered six years and a half after operation for right maxillary carcinoma in whom concomitant carcinoma of the gall-bladder was disclosed along with carcinoma of the stomach and later postmortem findings were obtained. The outline is reported here.

　The patient was a 68-year-old man. Past History: The patient had been receiving treatment for hypertension since 49 years of age. At the age of 61 he had an operation under the diagnosis of right maxillary carcinoma (histological diagnosis: keratinized squamous carcinoma) at the Department of Otorhinology, Hokkaido University Hospital. Following the operation, he was given a series of courses of radiation therapy with use of telecobalt unit and was thereafter followed up for about seven years during which no sign of recurrence was noted. Present Illness: On January 5, 1975, he began to complain of epigastric pain and feeling of abdominal distension. He was examined two days later when he was found to have impaired liver functions. On January 13, he was admitted to author's hospital for detailed examination. On admission, although hepatic dysfunction has already subsided, roentgenologic and endoscopic examinations revealed a polypoid protruded lesion in the antrum of the stomach. Histological examination of the biopsy specimen disclosed well-differentiated adenocarcinoma. On February 7, he was operated on with the diagnosis of type I early gastric carcinoma. At the operation, a mass about the size of a tip of the thumb was noted in the said portion of the stomach. The gallbladder was generally enlarged and appeared to have been displaced with tumor tissue over most part of the region extending from its fundus to corpus, with tumor infiltration even up to the serosal surface in limited areas. During operation he developed sudden incomplete A-V block and hypotension which compelled us to discontinue the operation. He became worse. Acute heart insufficiency setin; he died on fifth post-operative day with a complication of gastrointestinal hemorrhage.

　Postmortem examination revealed fresh, multiple ulcers (Ul-Ⅲ) in the fornix of the stomach, which were thought to have caused the bleeding, and an oval, polypoid protruded lesion with a short stalk at its base, measuring 2×2.5×1.5 cm, situated on the anterior wall near the lesser curvature in the antrum 4 cm from the pyloric ring. The lesion, a polyp cancer with degree of invasion m, was diagnosed histologically as papillary adenocarcinoma. In addition, a spheroidal mass of tumor tissue of 4×5×6 cm protruded from the fundus into the lumen of the gallbladder, occupying about three quarters of the inner space. The histological diagnosis for this lesion was adenosquamous carcinoma.

　On the ground of these findings, this case was diagnosed as unsynchronous primary triple carcinomas fulfilling the criteria of Warren and Gates. In view of the fact that concurrent multiple malignant tumors involving three or more organs of an individual is generally believed to be rare while the rate of detection of multiple tumors has been remarbably improved, homo- or heterochronia of development, incidence, combinations of matrices for malignant growths and related problems have been discussed with review of the literature and description of the peculiarity of this case.