多発隆起を伴った広範囲な未分化型胃癌の1例

Multiple Protruded and Widespread Mass Formed in Undifferentiated Gastric Carcinoma

　われわれは多発隆起を伴った広範囲な未分化型胃癌の極めてまれな症例を経験したので報告する．

　症　例

　患　者：64歳，女．

　主　訴：心窩部痛．

　現病歴：1978年1月初めごろより時々心窩部痛があり，食欲不振，約3カ月間に3kgの体重減少のため近医を受診し，精査のため同年3月27日入院となる．

　A 64 year-old female with three months history of epigastric pain and anorexia was referred to our hospital on March 27, 1978. On admission, physical examination revealed tenderness in the epigastrium. X-ray and endoscopic findings during the hospital course were not sufficient enough to make the differential diagnosis between malignant lymphoma and carcinoma of the stomach. Biopsy was positive for undifferentiated carcinoma with signet ring cell. Operation was performed on April 5, 1978 and with surgical exploration, multiple masses were palpable in the stomach wall and the liver and peritoneum were free from metastasis. The resected stomach showed multiple polypoid lesions with ulceration of the lower corpus and irregular mucosal surface with erosion was also noted. There was difficulty in diagnosing malignant lymphoma or carcinoma by gross appearance. Histological examination revealed undifferentiated carcinoma with signet ring cell involving almost entire mucosal layer of the stomach. The slight infiltration of cancer cells was found in serosa and muscularis propria and all of removed lymph nodes wer positive for cancer cells.