53ヵ所に多発病巣を認めた胃癌の1例

Multifocal Gastric Carcinoma Which Had 53 Foci, Report of a Case

　今回，われわれは胃内に50ヵ所以上の癌の多発を認め，しかもその過半数が長径5mm以下の微小癌であった胃癌の1症例を経験したので，文献的考察を加え報告する．

症例

　患　者：45歳，男性．

　主　訴：嘔気，項部痛．

　既往歴：特記すべきものなし．

　家族歴：父親，脳卒中．

　現病歴：1980年1月初めより，空腹時に嘔気を覚え近医受診，胃潰瘍と言われ投薬を受けていた．一方，10月末ごろより時々首筋の疼痛があったが，11月22日ごろより痛みが激しくなり，11月29日入院した．

　We experienced a case of multifocal gastric carcinoma which had 53 foci and the most of them were minute gastric cancers.

　The patient was 45 year-old man who was admitted with nausea and nuchal pain. U.G.I. series and endoscopic examination disclosed multiple differentsized depressed lesions with irregular margin at the angulus and the antrum. A depressed lesion without converging folds, clubbing and fusion of the folds was also noted at the posterior aspect of the lower gastric body, and furthermore, multiple minute depressed lesions were scattered all over the stomach. Total gastrectomy was performed with a diagnosis of multiple gastric carcinoma.

　Precise evaluation of the resected specimen disclosed that the foci of the gastric carcinoma were 53 and more than half of them (36 lesions) were minute gastric carcinomas of which long axis was less than 5 mm. Depth of their invasion was as follows: pm lesion was seen in one, sm was in two and the rest of them were early gastric cancers. Larger lesions were mainly found in the antrum and the angulus, and the minute lesions were mainly in the mid and upper portion of the gastric body. Regarding histological type, the majority of them were signet-ring cell carcinomas and in part, adenocarcinoma with ductal formation was noted elsewhere in the lymph ducts and vessels in the antrum and the angulus, but it was rarely noted at the lower and upper portion of the gastric body. Continuity of the each lesions was not demonstrated, therefore it was diagnosed as multifocal gastric carcinoma.

　Many cases of multifocal gastric carcinoma have been reported but the majority of them had 2～4 foci, and 25 foci which was reported by Yarita et al was extremely rare. Our case had 53 foci and it raises various interesting questions on development and growth of the cancer.