広範なリンパ管侵襲を来したⅡc型胃癌の1例

Type IIc Gastric Cancer with Lymphangitis Carcinomatosa, Report of a Case

要旨　患者は51歳，女性．主訴は心窩部痛．X線・内視鏡検査にて胃体部小彎から後壁の広範なⅡcと，その周囲の粘膜ひだの異常を認めたため，伸展良好なlinitis plastica型と診断し，手術を施行した．手術所見はS₀，N₄，P₂，H₀で両側卵巣に転移を認めた．病理組織所見は原発巣の直接浸潤が粘膜下層に止まった未分化型胃癌（Ⅱc型）で，粘膜下層を中心に広範囲にリンパ管侵襲を伴っていた。術後14か月で癌性腹膜炎のため死亡した．X線・内視鏡診断の立場で，癌性リンパ管炎による粘膜あるいは粘膜下層の浮腫性変化，つまり実際的には原発巣周囲の粘膜あるいは粘膜ひだの異常を捉えることが大切である．

　A 51-year-old woman complaining of epigastric pain was diagnosed by radiologic and endoscopic examinations as having so-called latent phase of linitis plastica type gastric cancer. Intraoperatively, the disease was considered at stage IV (S₀, N₄, P₂, H₀). Bilateral ovaries were metastasized.

　Pathological findings revealed primary lesion being type IIc macroscopically and undifferentiated type gastric carcinoma (sig.-por.) histologically. Although the direct invasion was not found beyond the submucosal layer, lymphatic permeation were widely scattered in the whole layer of the wall. All these findings were the basis of predicting anominous prognosis and she died of peritonitis carcinomatosa 14 months after the operation. Edematous change of the gastric wall, if detected by radiography or endoscopy, can lead to the diagnosis of lymphangitis carcinomatosa. Practically, therefore, one should pay utmost attention to the abnormality of gastric mucosa or gastric folds surrounding the primary lesion.