胃Adenoacanthomaの1例

A Case of Adenoacanthoma of the Stomach

　胃に原発するAdenoacanthomaは稀なもので報告例は極めて少ない．筆者らは最近，臨床的には胃平滑筋肉腫と考えられ，術後，組織学的に壁外性発育をしめしたAdenoacanthomaであった1例を経験したので報告する．

　Primary adenoacanthoma of the stomach is rare and only 16 cases including our case were reported in our country.

　The patient: Y.M. 40-year-old male.

　Chief complaint: Oppressive sensation of the abdomen and general fatigue.

　Past history: Hospitalization with chronic nephritis at the age of 32.

　Family history: Father died of stomach cancer.

　Present illness: In September 1971, he started to feel nausea at times and notice dark bloody stool. Tumor in the left upper abdomen was palpated in February 1972 and it developed in size gradually. Then, bloody stool became being noticed in every defecation and dizziness, paleness of the face, oppressive sensation of the abdomen and general fatigue developed. He was admitted to our hospital on June 26, 1972.

　Findings at the admission: A child's head size tumor was palpated in the left upper abdomen. Severe anemia and strongly positive occult blood in the stool were noted. The upper gastrointestinal series revealed a large round positive shadow of the tumor protruding extragastrically and oppressing the lesser curvature from cardia to duodenal bulb. A large deep ulcer with slightly elevated rolled margin was observed in the lesser curvature of the lower body of stomach. Sarcoma, especially leiomyosarcoma, was highly suspected and total gastrectomy was carried out on July 19, 1972.

　Findings of the resected specimen: The tumor was 17×12×7 cm in size protruded extragastrically from the lesser curvature of the stomach. Ulcer with the slightly elevated margin measuring 6.8×3.5 cm was noticed on the mucosa in the posterior aspect of the lesser curvature 4 cm orally from the pyloric ring.

　Histologically, the tumor was diagnosed as adenoacanthoma.