術後8ヵ月で再発し広範な転移を来したsm胃癌の1例

Recurrence of Early Gastric Cancer: Report of a Case Developing Extensive Metastases

要旨　治癒切除後8カ月で再発し，リンパ行性や血行性に広範な転移を来した早期胃癌の1例を報告した．患者は66歳の女性で心窩部痛を主訴として来院した．胃体上部小彎のⅡc型早期癌と診断し1980年8月噴門側胃切除術を施行した．深達度smの低分化腺癌で3番リンパ節に転移がみられたが，補助化学療法は行わなかった．術後8カ月左鎖骨上窩のリンパ節が腫大し，組織学的に胃癌の再発と確認された．その後皮膚や骨・肺への転移が出現し，肺炎と消化管出血を併発して術後1年8カ月で死亡した．剖検では前記転移のほか，頸部・胸部・腹部の諸臓器に転移がみられ，残胃漿膜面にもリンパ節を中心とする転移結節が認められた．本例の再発原因として転移リンパ節の遺残が推定され，早期癌でも噴門側胃切除の適応の決定には慎重でなければならないと考えられる．

　A 66 year-old woman presenting with epigastric pain was diagnosed to have a Ⅱc early gastric cancer and underwent proximal gastrectomy in August, 1980 (Fig. 1, 2, 3). Histologically, it was a poorly differentiated adenocarcinoma with regional lymph nodes involvement, invading the submucosal layer (sm) (Fig. 4, 5). No adjuvant chemotherapy was given.

　Eight months later, she developed swelling of a left supraclavicular lymph node, which was proved to be the metastasis of gastric cancer. She later developed metastases to skin, bones (Fig. 6) and the lungs. A year and eight months after operation, she died of pneumonia and gastrointestinal bleeding. At autopsy the metastases were widely seen in various organs and tissues.

　The recurrence in this case is presumed due to residual involved lymph nodes. Therefore, it is concluded that proximal gastrectomy should be indicated very cautiously even in early gastric cancer.