早期胃癌再発例―早期胃癌切除後6年半を経て再発，再手術を行ない早期胃癌であった1例

A Case of Recurrent Early Gastric Cancer: a case of recurrent early gastric cancer undergoing the second gastrectomy at six and a half years after the first gastrectomy due to early cancer

はじめに

　早期胃癌で胃切除を行ない，その後6カ月ごとにfollow-upを続けていたが，6年2カ月後に癌の再発が確認され，6年4カ月後に再手術を実施したところ，今度も早期胃癌であった症例を経験したので報告する．

　A 55-year-old man underwent a mass survey for gastric diseases with a gastrocamera approximately seven and a half years ago, and was diagnosed to have an ulcerative lesion within his stomach and was recommended to have further examination.

　After precise examination, gastrectomy was performed due to an ulcerative early gastric cancer on the greater curvature of the lower body close to the anterior wall.

　Microscopic examinations demonstrated type Ⅱc +Ⅲ of early gastric cancer and cancer cell infiltration was mostly limited within the mucosal layer, but partially invaded into the sutmucosal layer in a slight degree. The cancer cell infiltration on the anterior and posterior walls also extended to the margin of the surgical specimen on the lesser curvature.

　After the first gastrectomy he had worked at a factory and had been followed up at every 6 months by endoscope. In about one year after the surgery a small Ⅱc lesion appeared on the lesser curvature of the postoperative stomach close to the stoma and spread gradually. The lesion was diagnosed endoscopically as a difinite type Ⅱc lesion of ealry gastric cancer and was also demonstrated as cancer by biopsy and cytology 6 years and 2 months after the surgery. A total excision of the gastric remnant was performed at 6 years and 4 months after the first surgery.

　Microscopic examination of the removed specimen of the postoperative stomach demonstrated the same histological pattern of early gastric cancer (scirrhous type) as that of the first surgical specimen and most of cancer cell infiltration was limited within the mucosal layer but partial invasion into the submucosal layer was observed.

　This is a valuable case to know how early cancer spreads and how fast cancer is growing in scirrhous type of early gastric cancer, and also suggested to us that follow-up study was necessary to find early gastric cancer.