80個以上の病巣を有する多発胃癌の1例

Multiple Gastric Cancers Exhibiting More Than 80 Foci, Report of a Case

要旨　患者は70歳，女性．胆石症の術前胃X線検査で胃の異常を指摘された．胃X線検査では，噴門および穹窿部から前庭部にかけて1～2cm大の浅い不整陥凹が多数散在していた．胃内視鏡検査でも同様に，胃のほぼ全域に辺縁が軽度隆起した1～2cm大の白色調の不整形陥凹が多数散在していた．生検結果はGroup Ⅴで，印環細胞癌であった．胃全摘出術を施行した．切除胃の詳細な肉眼的および組織学的検索により，互いに連続性のない80個以上の病巣を有する多発胃癌と診断した．組織型は印環細胞癌，深達度はpmが3病巣，smが10病巣，その他はすべてmで，p₂H₀n₂(＋)であった．10個以上の病巣を有する多発胃癌は極めてまれであるので報告した．

　A 70-year-old woman was admitted to our hospital because of abnormality of the stomach. This was found during preoperative examination for cholelithiasis. Barium meal study of the stomach showed multiple irregular-shaped shallow barium flecks 1-2 cm in size which were located from the cardia to the antrum (Fig. 1). Endoscopy revealed multiple irregular-shaped whitish shallow depressions with slight marginal elevation throughout almost the entire stomach (Figs. 2 and 3). Endoscopic biopsy demonstrated signet-ring cell carcinoma.

　Total gastrectomy with R₂ lymphadenectomy, cholecystectomy, and resection of a left ovarian cyst, which was found incidentally during the operation, were carried out. On gross and histological examinations, more than 80 separate cancer foci were recognized (Figs. 4-6). Histology of the cancer was mainly signet-ring cell carcinoma. Three foci out of all the lesions had invaded the proper muscular layer. Ten foci had invaded the submucosal layer, and the others had invaded the mucosa only (Fig. 7). Histologically, metastases to the wall of the resected ovarian cyst, and to the regional lymph nodes of the stomach, were found.