胃villous tumorの1例

Villous Tumor of the Stomach, Report of a Case

要旨　患者は59歳，男性．空腹時心窩部痛を主訴として来院．胃X線・内視鏡検査にて2個のvillous tumorを認めた．極めて柔らかな隆起で，表面は“soap-bubble”様の所見を呈し，生検用鉗子を隆起の奥深く容易に挿入できた．切除胃にて，1個は大きさ12×9.5×1.5cm，小さな癌巣の散在するcarcinoma in villous adenomaであり，他の1個は大きさ2×1.5×3.5cm，villous adenomaであった．術前著明な低蛋白血症(5.2g/dl)があったが，胃切除後正常化した．

　A 59-year-old man was admitted to the hospital with a 3-month history of epigastralgia. On physical examination the patient appeared thin but well. Laboratory findings revealed hypoproteinemia (total rotein 5.2g/dl, albumin 3.2g/dl)and hypocalcemia(serum calcium 7.7mg/dl). Upper gastrointestinal series demonstrated two pliable, lobulated tumors inthe distal stomach, both of which showed the lacy “soap-ubble” appearance characteristic of the villous tumor. One of them prolapsed into the duodenal bulb. Endoscopic view of the tumors showed a lobulated surface with mild reddening. The tumor was so friable that it was easy to insert the biopsy forceps into the tumor deeply. The partial gastrectomy was performed, because of the possibility of focal cancer, although histological examination of the biopsy specimen revealed adenoma(groupIII). There were two sessile protubelant lesions, measuring 12×9.5×1.5cm and 2×1.5×3.5cm respectively, in the resected stomach. Both of them had a shaggy surface composed of numerous frond-like processes. Microscopically the two tumors consisted of finger-like projections of neoplastic epithelium with a lamina propria projecting towards the lumen, i. e. villous adenoma. The larger one had small foci of well differentiated adenocarcinoma. Two days after the operation, hypopro. teinemia and hypocalcemia improved(total protein 6.7g/dl, albumin 3.8g/dl, calcium 8.6mg/dl). It is suggested that hypoproteinemia was due to proteinlosing from the villous tumor.