スキルス胃癌の大腸への浸潤性転移の1例

Scirrhous Gastric Carcinoma with Invasive Metastasis to the Colon, Report of a Case

要旨　20歳，女性．右下腹部痛と嘔吐を主訴に来院し，イレウスの診断にて入院．注腸X線検査にて，上行結腸中部の閉塞像とそれに連続した上行結腸上部の一側性鋸歯状辺縁と平滑な腫瘤陰影を認めた．大腸内視鏡では病変の中心部には炎症性ポリープ様の結節が山脈状に連なった像を呈し，その肛門側ではハウストラの消失を伴った粘膜下腫瘍像に，口側は狭窄像に移行していた．開腹所見はスキルス胃癌が胃周囲より連続性に後腹膜に沿って上行結腸に浸潤していた．転移性大腸癌の注腸像，内視鏡像は特異な所見を有しており，それらを詳細に検討することが原発巣の同定に有用と考える．

　A 20-year-old woman was admitted to our hospital because of right lower abdominal pain and vomiting. She was diagnosed as having ileus by abdominal x-ray film. Barium enema study revealed obstruction at the mid-portion of the ascending colon (Fig. 1), as well as fine waving outline and lobulated mass shadows which formed posterior wall of the upper part of the ascending colon (Fig. 2). Colonoscopy demonstrated the mass looking like submucosal tumor at the edge (Fig. 3) merging into smooth nodular elevations at the middle (Fig. 4). Stenotic area was edematous with red spots (Fig. 5).

　The patient underwent laparotomy. The stomach, presenting so-called leather bottle (Fig. 6), was firmly adherent to the ascending colon through the retroperitoneum. Biopsy specimens from the stomach (Fig. 7 a) and fat tissue around the ascending colon (Fig. 8 b) included poorly differentiated adenocarcinoma, determining the lesion of the ascending colon being invasive metastasis from scirrhous gastric carcinoma. Operation was confined to ileo-transverse colon anastomosis. Barium meal study performed after operation showed typical scirrhous gastric carcinoma (Fig. 8).