多発胃癌，とくに多発早期胃癌について

MULTIPLE PRIMARY CANCER OF THE STOMACH; WITH SPECIAL REFERENCE TO GASTRIC CANCER IN ITS EARLY STAGE

Ⅰ．はじめに

　胃癌の大部分は単中心性の病巣を示すが，ときに2個以上の癌病巣がそれぞれ独立して存在するいわゆる多発胃癌に遭遇することがある．多発胃癌は1855年Barth¹⁾によってはじめて報告されて以来，病理組織学的立場から注目されていたが，近年臨床の実際においても遭遇することが必ずしも少なくないことが，諸家の研究により明らかにされ，胃癌の予後の上から重大な問題として，臨床的にも重視されている．

　そこで本稿では，まず多発胃癌の概要について述べ，ついで多発早期胃癌に重点をおいて記述することとする．

　During the 21 years from 1946 to 1966, a total of 176 cases of multiple primary cancer of the stomach (149 cases of double, 20 cases of triple, and 7 cases of quadruple carcinoma) were observed in the Cancer Institute Hospital. The incidence of multiple gastric cancer was 4.38% of a total of 4,015 cases operated for gastric cancer, and 5.22% of a total of 3,374 cases of resected gastric cancer. During the 11-year period from 1946 to 1956, the number of multiple gastric cancer was 39 cases, While that from 1957 to 1966 was 137 cases, the incidence being about twice in the latter 10-year period.

　Out of these 176 cases of multiple cancer of the stomach, gastric cancer in an early stage was present at the same time in 26 cases. Of these, 18 cases (69%) were found during the recent three years. And those of the early and advanced stages were present at the same time in 102 cases, and advanced gastric cancer was present in 48 cases.

　Sex difference in 181 cases of multiple gastric cancer, including 5 cases of double carcinoma of the stomach originating at different times, showed overwhelmingly greater incidence in the males, there being 143 males and 38 females (sex ratio 3.76). In age distribution, the oldest patient was 79 years and the youngest, 38 years, 60% of this group being above 60 years of age, with a peak in the 60’s. The average age was 61.0 years.

　Of the 60 carcinomatous foci in 26 cases of early multiple gastric cancer, the most common were 36 (60%) of protruded (Type Ⅰ) and elevated (Type Ⅱa) types, followed by 15 (25%) of the depressecl type (Type Ⅱc or Ⅱc+Ⅲ). From histological examination of the 60 carcinomatous foci 'adenocarcinoma tubulare medullare was found most frequently, the number being 36 (60%), and the next being 17 (28%) of adenocarcinoma papillotubulare. Lymph node metastasis was confirmed 7 (29%) of 24 cases. Complications were fouml in 17 (65%) of 26 cases. There was a general tendency for the presence of ulcer scar, polyp, benign erosion, and atypical epithelium in the same stomach.

　In conclusion, it is pointed out that multiple cancer of the stomach is seen in a fairly high incidence, and that there seems to be a tendency for higher incidence of triple and quadruple carcinoma in the multiple gastric cancer of an early stage and that other benign changes are often present in the same stomach. It is necessary, therefore, to examine whole of the stomach, even if one cancerous focus has been found, in order to eliminate any other coexisting malignancy in other parts of the stomach.