胃カルチノイドの1例

CARCINOID OF THE STOMACH

Ⅰ．はじめに

　近年消化管カルチノイドの報告が次第に増加してきて本邦報告例も1968年までに67例を数えるが，そのうち胃のカルチノイドは僅か8例に過ぎず比較的稀である．最近著者らは典型的なカルチノイド症状を欠き，胃X線および内視鏡検査で胃粘膜下腫瘍と診断して胃切除を行ない，病理組織学的検索によりカルチノイドと判明した43歳女子の1例を経験した．腫瘍は粘膜下層内に限局し，浸潤性発育の像を認めなかったが，約1年後肝に転移性腫瘤を形成し，再開腹により腫瘤を摘出してそれを確認したのでここに報告し考察を加えてみたいと思う．

　A case of carcinoid of the stomach recently experienced is described here with some comments on it by correlating it with allsuch cases reported so far in this country.

　A woman 43 years of age underwent gastrectomy on provisional diagnosis of submucosal tumors of the stomach as two neoplasms of different size had been confirmed in it by as well x-ray as by endoscopy. Histologically both of them proved to be carcinoid. Although both of the tumors, confined within the submucosal layer, had no vestige of infiltrative development, a metastatic tumor was found one year later in the liver. Histological specimen of the tumor, which was excised by relaparotomy, revealed it as of the same neoplastic variety.

　This case is believed to be the ninth case ever reported in this country of carcinoid of the stomach. Through all the stages of its evolution, it lacked any characteristic features of carcinoid, as exemplified by the absence of silver affinity intumor cells. Positive 5-HIAA in the urine and 5-HT in the blood are of great account in the preoperative diagnosis of carcinoid, but they do not always hold true on all occasions. Exact clinical diagnosis is therefore very diflicult.

　It is emphasized that carcinoid of the stomach, hitherto regarded as of benign nature, should be conceived as belonging to neoplasms of malignant nature.