20年目に発生した異時性胃重複癌の1例

Double Unsynchronous Cancers of the Stomach with an Interval of Twenty Years

　従来，重複癌とは2つ以上の癌が，それぞれ異なった臓器に発生した場合に用いられてきたが，Warren＆Gatesの重複癌定義の修正以来，1つの臓器に複数の癌が発生した場合も，その各々が互いに独立したものであれば，重複癌と言われるようになった．

　一方，重複癌は発見時期から，6カ月以内に発見された場合は同時性重複癌といい，6カ月以上の間隔のあるものは，異時性重複癌といわれている¹⁾．また，一般に同一臓器内に発生した同時性癌は多発癌と習慣的に呼ばれている²⁾．

　A case of gastric cancer is described here that arose from the gastric remnant of a 65-year-old man 20 years after surgical operation for gastric cancer.

　In April 1952 he underwent subtotal gastrectomy (Billroth Ⅰ) on account of gastric cancer (Borrmann type Ⅰ) in the lesser curvature side of the antrum. At operation then, no cancer metastasis was confirmed either in the gastric stump or in the regional lymph nodes. He underwent periodic check-ups of the stomach thereafter. At a gastric mass screening in April 1972, an abnormality was found in his stomach. He was then referred to our Department of Internal Medicine. X-ray pictures of the gastric remnant disclosed a shadow defect in the lesser curvature side along with marginal rigidity. Irregular mucosal folds were seen to converge toward the defect. On the lesser curvature slightly on the anterior wall side endoscopy revealed an elevated lesion with a shallow ulcer in the center. Partial erosions with bleeding spots were seen there, but the mucosa of the anastomosed region or the that of duodenum appeared normal. Biopsy disclosed adenocarcinoma tubulare, and gastrectomy was performed. Grossly the lesion measured about 8 by 4 cm, and it did not involve the anasto-mosed region. Histologically as well, the site of anastomosis was free from cancer. The lesion reached from the mucosal side to the submucosal layer, partially involving the serosa.

　We came to the conclusion that the present case was not recurrence of the initial cancer but unsynchronous doubled cancer because the first lesion was localized with no metastasis to the anastomosed region, regional lymph nodes or to other organs; because the present lesion was clearly located away from the initially excised stump with a very long time interval of 20 years in between.

　In the literature on this subject we find during the past seven years in this country only several reports of unsynchronous double cancers of the stomach the second cancer occurring after an interval of more than twenty years. Our rare experience indicates that meticulous follow-up of gastrectomized cancer patients would surely increase in number of detection in double cancers of the stomach arising after a very long time as is seen in the present case.