胃に特異な拡がりを示した食道癌の1剖検例

An Autopsied Case of Esophageal Cancer showing Peculiar Encroachment on the Stomach

　胃の扁平上皮癌は非常にめずらしいものの1つである．世界の文献上，まだ30数例しかないとされているが，しかし胃の原発性扁平上皮癌として報告されているものの中に，食道の小さな癌病巣から，胃へ転移してきたものが含まれていることが指摘されている¹⁾．

　ここに報告する例は，食道の癌そのものは粘膜のごく軽度の肥厚を示すのみであったが，胃では腫瘍の転移浸潤のため胃壁全体が非常に厚くなりBorrmann Ⅳ型のかたちできていた症例である．

　Hematernesis and melena persisted despite medical management in a 70-year-old man who had been admitted to hospital because of hematernesis, so that he had to undergo emergency operation. A tumor-like rigidity and hypertrophy was noticed then extending from the corpus down to the pylorus.

Lymph node metastasis was recognized as well. He was in such a weak condition that we were compelled to perform only subtotal gastrectomy (Billroth Ⅱ). Two months later cancer recurred and the patient succumbed eight months after the onset of the disease.

　Comparison of the removed stomach and the autopsied findings showed that while squamous cell carcinoma in the lower esophagus remained there as a mere slight thickening of the mucous membrane, the metastasized and infiltrated stomach revealed marked mural hypertrophy in its entire length, presenting a picture of scirrhous carcinoma.

　Squamous cell carcinoma constituting the greater majority of esophageal cancer is said to have relatively few metastasis to other organs, and though advanced carcinoma of the same variety may at times present continuous encroachment on the cardia,yet the present case indeed has shown a very uncommon way of cancer invasion.