6年間経過観察後手術を施行され1年9ヵ月後に再発死亡した早期胃癌の1例

Recurrence of Early Gastric Cancer in a Patient Dying in Short Time after a Long Term Follow-up a Gastric Polyp and the Gastrectomy, Report of a Case

要旨　患者は58歳の女性，手術の6年前より，人間ドックの胃X線検査や胃集検で，胃噴門下部後壁のポリープの診断を受けていた．胃内視鏡検査および胃生検は施行されなかった．胃集検で要精査となり，胃内視鏡および胃生検が施行され，GroupⅤ（papillary tubular adenocarcinoma）と診断され，胃全摘・脾摘・食道空腸吻合術を施行した．術後1年4カ月でVirchowリンパ節腫脹術後1年9カ月で死亡．剖検により全身転移，特にリンパ節転移が著明であった．切除標本の病理組織学的診断は，初めm癌とされ，リンパ節転移(－)だったが，見直しによりsmのリンパ管の腫瘍塞栓を認めた．

　The patient, a 58 year-old woman, had no complaint, but her gastric polyp had been followed-up as benign lesion for six years by x-ray examination.

　The gastrofiberscope and endoscopic biopsy showed that a small elevated tumor on the posterior wall of the cardia was cancer. Total gastrectomy, splenectomy and esophago-jejunostomy were performed in June 1978. No metastasis was found in the resected regional lymph nodes.

　The Virchow's node was swollen in one year and four months later, and she died in one year and nine months after the operation. Autopsy showed wide spreading metastases, mainly lymphatic.

　Microscopic examination of the resected stomach showed that the polypoid cancer of the cardia was intramucosal remaining of the atrophic non-cancerous glands in the deep mucosal layer. But the tumor emboli were found in the submucosal lymphatic vessels at the re-examination. Pathological diagnosis was 1) papillary adenocarcinoma of stomach with tumor emboli of submucosal lymphatic vessels, 2) chronic gastritis, verrucosa and follicularis, transitional type (Sano). Concerning the histogenesis of this gastric polypoid cancer, we think it must have been based on gastritis verrucosa.

　In our hospital, from 1964 to 1973, early gastric cancer numbered 190 cases, and 141 cases belonged to those of ten-year-survival (74.2%). The ten-year-survival rate of early gastric cancer excluding the unknown, the other disease death and the operative death, was 96.6%.

　All of the recurrent cases in 466 cases of early gastric cancer. 1964 to 1978, were 13. The shortest postoperative survival period was six months and the longest nine years and eight months. We conclude the recurrence factors of early gastric cancer as the following points;

　1) the macroscopic form is elevated type,

　2) papillary adenocarcinoma,

　3) early gastric cancer with submucosal and lymphatic invasion and lymph node metastasis.