平滑筋肉腫と2個の腺癌が同一胃に併発した三重複癌の1例

Coexistence of Leiomyosarcoma and Two Histologically Different Adenocarcinomas in the Stomach, A Rare Combination

　同一臓器における多発癌腫発生はそれほどまれなものではないが，発生母地を異にする悪性腫瘍の併発は極めて珍しい．われわれは平滑筋肉腫と2個の腺癌が同一胃^1)～3)に発生した症例を経験したのでここに報告する．

　A 57-year-old farmer came to Kanetsu Hospital with a complaint of hunger epigastralgia of about two months duration. Physical and laboratory examinations disclosed no abnormalities. Upper gastrointestinal roentgenograms and gastrofiberscopy demonstrated a large submucosal tumor in the fornix and a small protruding lesion with central ulceration in the antrum. Biopsy showed adenocarcinoma in the antral lesion, but failed to obtain diagnostic specimens from the submucosal tumor. Total gastrectomy with lymph nodes dissection was performed.

　In the resected stomach, another small depressed lesion was found on the pylorus. Microscopic examinations revealed leiomyosarcoma in the submucosal tumor, poorly differentiated advanced adenocarcinoma invading into the propria muscularis in the antral lesion, and well differentiated early adenocarcinoma limited to the submucosa in the pyloric lesion.

　We suspect the fate of this patient will most probably depend on the course of the tumor with the poorest prognosis, that is the poorly differentiated adenocarcinoma in the antrum with the five-year survival rate of about 70% in such a case.

　We would expect development of more reliable methods in the near future to make a correct diagnosis before surgery, particularly in the case of submucosal tumor, since presently available diagnostic means including roentgenologic and endoscopic examinations can not always give us a definite diagnosis.