高度のリンパ管侵襲のため深達度と浸潤範囲の判定が困難であった胃癌の1例

Advanced Gastric Cancer Simulating Early Cancer (Ⅱb+Ⅱc), Report of a Case

要旨　患者は61歳男性．心窩部不快感を主訴とし，胃X線検査で前庭部の胃小区の不整と壁の硬化像を認め，内視鏡検査で前庭部に全周性の胃粘膜の発赤，粗糧と幽門近くの小彎側後壁に小さな浅い陥凹がみられ，Ⅱc型早期胃癌と診断された．1983年6月24日胃部分切除術が施行され，口側切除線は前庭部の粗縫な胃粘膜領域から7.5cm離し，S₀P₀H₀N₀でR₂のリンパ節郭清が行われた．組織学的には，粘膜層は印環細胞癌で，粘膜下層への直接浸潤が一部にみられたが，リンパ管侵襲が高度であり，このため癌は漿膜に達し（se），更に口側へは粘膜下層以下を浸潤し，口側断端浸潤陽性（ow(＋)）であった．

　We reported here a 61 year-old man with advanced gastric cancer which looked like a superficial cancer frequently encountered. Macroscopically the lesion was located at the antrum with slight depression with the mucosa oral to it appearing normal. Partial gastrectomy was carried out with free oral margin of 7.5 cm. Grossly, intraoperative findings were Stage Ⅰ; no serosal invasion; no regional lymph node metastases; no peritoneal dissemination; no liver metastasis.

　Histological study, however, revealed that poorly differentiated adenocarcinoma with extensive invasion to the lymph vessels deep into the serosa as well as to the gastric stump.

　Ten months after the gastrectomy, re-gastrectomy was performed. But the patient died of peritoneal cancer dissemination four months later. Cytophotometric DNA analysis showed low ploidy pattern in both primary and remnant lesions.