早期11多発胃癌の1症例

AN EARLY CASE OF MULTICENTRIC CANCER OF THE STOMACH

Ⅰ．まえがき

　最近多発早期胃癌の症例報告が散見されるようになった．我々も胃癌の多中心性発生の問題を考えるのに興味深い11個の隆起性早期癌を多発した症例を経験したので報告する．

　Patients: Male, 73 years of age.

　Main Complaints: Anemia, internal bleeding and palpitation of the heart.

　Family History: One elder brother's death attributed to the cancer of the rectum.

　X-ray Diagnosis: Polyposis of the stomach (malignancy suspected). Six of the polyplike protuberance and 3 of the mound-like prominence were detected. Most of the former were either determined or presumed to be pedunclated. The surface conditions and the state of the protrusion were enough to indicate the early stage of Type Ⅱa stomach cancer.

　Endoscope Diagnosis: Five of the polyp-like protuberance and 3 of the plateau- or mound-like protrusion were detected. The surface of the former was rough, and several showed surface bleeding. The early stage of Type I or Type Ⅱa stomach cancer was suspected.

　Tissue Diagnosis: Chymopsin lavage yielded several pieces of tissue. Adenocarcinoma was apparent.

　Pathological Diagnosis: On the posterior and the anterior walls, 6 each of the protuberance were detectecl. The two polyp-like protrusions the size of a nut on the posterior wall of the corpus, since they share the same stalk, were determined to be one. Thus the number was 11. All of the 5 polyp-like ones were pedunclated, two being with rather long stalks and three being with rather short ones. There were altogether six mound-like protuberances, the largest being the size of 37×30×28 mm, while the smallest being the size of 12×12×1 mm Neither X-ray nor endoscope was able to detect before the operation the three mound-like protruding lesions on the anterior wall. Pathologically speaking, all of them were adenocarcinomas, the only difference being in the advanced degree of development with the polyp-like structure in comparison with the not so advanced degree with the mounds. With the exception of one mound-like protrusion on the posterior wall of the pylorus, all were the very early stage of the cancer of the stomach, limited within the mucosa. The exceptional case infiltrated below the mucosa. Metastasis to the regional lymph nodes or vessels was non existent.

　In this article, some comments are made as to the multicentric cancer of the stomach, to the early stage of it in particular.