早期胃癌の術後に7年の興味ある経過をたどった遺残癌の1例

Recurrent Early Gastric Stump Cancer, Report of a Case

　本症例は広範囲隆起性早期胃癌で，内視鏡および病理組織学的に多彩な様相を呈した症例として既に報告¹⁾したのであるが，術後に断端部遺残が認められていた．その経過観察中に遺残癌による症状が出現し，7年目に残胃を全摘したところ，初回の摘出胃標本と同じような早期癌の状態であったという興味ある経過をたどったので，その詳細を報告する．

　The patient, a 65 years old man, suffered from recurrent early gastric stump cancer seven years after the subtotal gastrectomy for extensive early gastric cancer of protruded type. The previous specimen was studied by serial sections and it was revealed that the greater part of the gastric mucosa was replaced by cancerous tissue. The cancer growth was almost limited to the mucosal layer with partial submucosal invasion. Unfortunately, the proximal section line was found to be positive for cancer in this study. In spite of the doctor's recommendation, the patient refused to undergo subsequent operation.

　After three years and eight months of the followup, the gastric side of the stoma was first found to be changed by x-ray study. The clinical symptom appeared six and half years after the primary resection. Finally, the gastric stump was totally resected by 1t. thoracotomy with extended laparotomy approach seven years after the primary resection. The pathological diagnosis was well differentiated adenocarcinoma. This was the same as the previous specimen. Furthermore, the cancer growth was also limited to the mucosal and submucosal layer of the gastric stump.