症例8 14歳（♀）の進行胃癌

A Case of Advanced Gastric Cancer in a 14-Year-Old Female

　患者は14歳女子．昭和45年9月頃より食後心窩部痛あり，漸次全身るそう，貧血著明となり来院．同年11月胃立位X線撮影にて，胃角部より幽門前庭部にかけ壁硬直，前庭部の伸展不良あり，腹臥位X線撮影にては大なるCraterを伴う陰影欠損が認められる（図1，2）．ファイバースコープ検査では，図3のような大きな進行癌を確認した．

　手術所見　胃体部より幽門前庭部にかけ，漿膜におよぶ腫瘤を認めるも，肝，膵，腹膜，卵巣などに肉眼的転移を見ず，従って大網全剔，所属第1群及び第2群リンパ節廓清を含む胃切除術（Billroth Ⅰ法）を施行した．後述するようにこの症例はn₂（＋）であったので，結果的には相対的治癒切除に終った．

　The patient, a 14-year-old girl, had postprandial pain in the epigastrium since September 1970, and gradually she lost weight with increasing anemia. She was examined by x-ray in November of the same year. In an upright, barium-filled picture, rigidity of the gastric wall from the angle down to the antrum was noticed. The antrum was less distensible than was normal. A prone picture revealed a shadow defect with a large crater in it (Figs. 1, 2). Fiberscopic examination demonstrated a large advancer carcinoma (Fig. 3).

　Findings at operation : A large tumor was seen from the corpus down to the pyloric antrum, invading even the serosa. Howevr, as no macroscopic metasiasis was seen in the liver, spleen, peritoneum and ovaries, total resection of the greater omentum with gastric resection (Billroth Ⅰ) was carried out including the removal of the regional primary and secondary groups of lymph nodes. Nevertheless, our operation was after all a relatively curative resection, as this case n₂ (＋), as shall be shown later.

　The resected specimen (Fig. 4) showed advanced carcinoma Ⅲ). Histologically it was adenocarcinoma mucocellulare scirrhosum (Fig. 5), CAT Ⅲ, SAT 3, INE γ, showing a highest grade of malignancy. It was s₂, ly₂, v₀, aw (－), ow (－). Metastasis to the regional lymph nodes around the basal part of the celiac artery was (＋) 7/7, with subpyloric nodes (－) 0/3, and inferior gastric nodes (－) 0/5.

　The postoperative course was favorable until three months later, when she was attacked with severe lumbar pain most probably caused by retroperitoneal metastasis. It was soon followed by carcinomatous peritonitis. She died shortly thereafter.