胆囊癌と合併せる早期胃癌の1例

A CASE OF EARLY GASTRIC CANCER ASSOCIATED WITH CARCINOMA OF THE GALLBLADDER

Ⅰ．はじめに

　同一個体に発生する重複悪性腫瘍に関しては，1869年Billroth¹⁾が初めて発表して以来，多くの報告がなされているが，しかし胃および胆囊の重複悪性腫瘍に関する報告は極めて少ない．筆者ら今回，早期胃癌と胆囊癌の重複腫瘍という極めてまれな1例を経験したので報告する．

　Double malignant tumors were first descrihed by Billoth in 1869. Recently a very rare case of double cancers, that of the gallbladder associated with early one of the stomach, has been encountered.

　A man 69 years of age visited the authors' hospital with anorexia as his chief complaint. At x-ray and endoscopic examinations, a broad-based protuberance the size of a forefinger-tip was visualized on the posterior wall of the corpus. This lesion was diagnosed as type I early cancer by the changes on its surface. In the course of the operation, a soft tumor was detected on the posterior wall of the corpus as well as a hard tumor the size of a sparrow's egg in the collum of the gallbladder. The latter extended all the way around its wall. Under the diagnosis of double tumors of the stomach and the gallbladder, gastrectomy and cholecystectomy were performed. Histologically the gastric tumor belonged to adenocarcinoma tubulare confined within the mucosa, while the tumor of the gallbladder was adenocarcinoma papillare encroaching on the serosa. Both are completely different not only in the histological picture and atypicality of tumor cells but also in the degree of their atypical distribution and the depth of cancer invasion. Furtheremore, inconceivable as it was that discontinued metastasis between gastric cancer localized within the mucosa and cancer of the gallbladder should take place, these tumors seemed to satisfy the criteria of double malignant tumors as defined by Warren. The incidence is in this country about 0.7 per cent, a far lower figure as compared with that of Western countries, but the bulk of their incidence is found in the digestive tract; it accounts for more than 75 per cent of all double malignant tumors. However, the stomach and the gallbladder have only rarely been reported. In Japan, as far as the authors were able to find out, only 8 cases have been presented so far since the initial report of Fukuda in 1935. The case here described is therfore the ninth. As for early cancer of the stomach associated with carcinoma of the gallbladder, it has never been reported.

　Inasmuch as double malignant tumors in the digestive system show a very high incidence, the case here presented gave the authors material for retrospection as it made them keenly aware, in the surgical intervention of tumors of the digestive tract, of the necessity of thorough examination not only during, but also prior, to the operation.