術後9ヵ月の短期間にリンパ節，肺転移を来し死亡したⅡa＋Ⅱc型重複癌の1例

Recurrence Due to Lymph Node and Lung Metastasis of Early Gastric Cancer, Ⅱa+Ⅱc Type Nine Months after Radical Operation

要旨　患者は65歳，男性．1980年7月14日術前診断Ⅱa＋Ⅱc型重複胃癌にてR₂郭清の根治手術．術中所見はN₁S₀H₀P₀，胃病変はM小彎中心の大きさ4.5×4.0cm，2.5×2.0cmのⅡa＋Ⅱc型早期胃癌．腹腔内臓器にはほかに異常は認めない．組織学的には，両者ともpapillo-tubular adenocarcinomaであった．口側の病変はsm深部浸潤型であり，ly₁，v₁であった．術後7カ月ごろより体重減少著明となり，9カ月目に腹腔動脈周囲リンパ節と肺転移を来し，術後12カ月で死亡に至った．Ⅱa＋Ⅱc型重複早期胃癌の短期再発死亡例を報告した．

　A 65 year-old man was referred to our hospital for operation of Ⅱa+Ⅱc type, early gastric cancer by a certain physician on July 9, 1980. Preoperatively, he was diagnosed as having Ⅱa+Ⅱc double early gastric cancer, located on the lesser curvature of the antrum and angulus. Radical gastrectomy (R₂), (N₂H₀P₀S₀) was performed at the department of surgery in our hospital. Macroscopically, two gastric lesions were diagnosed as double early gastric cancer, Ⅱa+Ⅱc, measuring 45×40 mm (a) 25×20 mm (b) on the lesser curvature of the A and M area. Histologically, both lesions were adenocarcinoma papillotubulare and the depth of invasion was in the submucosal layer. A lesion had massively involved to submucosal layer with the infiltration to lymph node (ly₁) and veins (v₁). Other organs in the abdomen were diagnosed as normal at the operation. He was discharged from our hospital on Aug. 16, 1980 without adjuvant chemotherapy and was followed-up by a certain physician. Since the first of February in 1981, he noticed a loss of body weight. On April 17, 1981, he was referred to our hospital under a suspicion of diagnosis of recurrence of gastric cancer. CT examination was performed and was diagnosed as the recurrence of gastric cancer due to lymph nodes and lung metastases. He was admitted again to our hospital on April 17, 1981. In laboratory data, LDH and CEA level were slightly rising during hospitalization. He received cancer combination therapy (MMC 100mg, 5-FU 39g) but died of cancerous cachexia on July 19, 1981, just 12 months after radical operation. Through this case, we discovered that deep invasion into the submucosal layer of Ⅱa+Ⅱc type early gastric cancer must be given treatment for advanced gastric cancer.