Ⅱc型早期胃癌から肝転移し2年6ヵ月後に死亡した1例

Minute Gastric Cancer with Liver Metastasis, Report of a Case

要旨　患者は49歳の男性．1975年10月ごろ左上腹部痛が続き胃X線ならびにGTFで胃前庭部小彎前壁寄りのⅡa＋Ⅱcと診断され，1976年4月に胃切除術を施行された．切除胃でみると，同部の5×6mm，周囲の軽い盛り上がりのあるⅡc型早期胃癌であり，組織学的に粘膜下層に達する未分化型癌であり，リンパ節転移はみられなかった．術後2年3カ月目に黄疸が出現し，腹水，肝腫を触知した．CT，US，腹腔鏡で肝の多発性腫瘍像を認め2年6カ月目に死亡した．病理解剖学的診断は肝の多発性転移性癌，膵を巻き込む周囲リンパ節の大きな腫瘤が，三管合流部直下を圧迫し，総胆管閉塞がみられた．肺にも小さな転移巣が認められたが，胃吻合部粘膜には癌の再発はみられなかった．

　About October, 1975, the patient, 49 year-old man with persistent upper abdominal pain entered hospital for early gastric cancer in the antrum at the lesser curvature confirmed by gastric x-ray examination and gastrofiberscope.

　He was operated on in April, 1976. Operation specimens revealed Ⅱc type early cancer (5×6 mm) with surrounding slight elevations. Histopathologically, it was a poorly differentiated adenocarcinoma limited to the submucosa and without any metastasis in the regional lymph node. About two years and three months after operation, there appeared general malaise and icterus with liver swelling, and subsequently ascitis was also observed. US, CT scan and laparoscope examination revealed findings indicating multiple liver tumor. He died two years and seven months after operation. This case was pathologicoanatomically diagnosed as gastric carcinoma with recurrent metastasis in the liver and multiple microscopic metastasis in the lung and also with obstruction of common bile duct by tumor invasion.