胃癌，胃迷入膵，胆石症に合併した胃脂肪腫の1例と文献的考察

A Case Report of Gastric Lipoma accompanied with Gastric Cancer, Aberrant Pancreas and Cholelithiasis

　胃良性腫瘍のなかで脂肪腫は本邦および欧米の文献からみてもその報告は稀である．最近，著者は胃癌，胆石症，迷入膵に合併した胃脂肪腫を経験したので，文献的考察を加えて報告する．

　Gastric lipoma is one of the rarest benign tumors of the stomach and a review of the available literature shows that compared to other such tumors of this organ, very few cases have been reported so far. Up to 1974 only 45 cases had been reported in the Japanese literature.

　A 63-year-old man complaining of hunger pain in the epigastrium was admitted to the author's hospital. In the two months prior to admission epigastric pain had become severe and constant. Physical examination on admission was not remarkable and laboratory studies reported nothing of significance except for slight hypoproteinnemia.

　Radiography of the stomach revealed an antral filling defect due to advanced gastric cancer, but no submucosal tumor was found out by barium X-ray studies. Gastroendoscopic examination showed Borrmann III type cancer in the antrum and corpus.

　At operation an upper midline incision was made and gastric cancer occupying the antrum and corpus was seen besides a light-brown tumor (aberrant pancreas) noticed at the anterior wall of antrum. It was soft to palpation as was the serosa overlying it. Gallbladder stones were also palpable.

　Subtotal gastrectomy with transmesocolic gastro-jejunal anastomosis and cholecystectomy were done.

　He was discharged on the 21 st postoperative day after an uneventful recovery. The specimens consisted of the distal four-fifth of the stomach with prominent tumoral masses located in the antrum. In a section through this, there appeared tumor masses with the characteristics of a lipoma, 1.7×1.2 cm, yellowish and translucent, and of an aberrant pancreas, 3.0×2.8 cm, light-brown, with elastic consistency.

　The microscopic examination of the tumoral masses showed them to consist of mature adipose tissue and pancreas tissue.

　The histopathologic diagnosis was a lipoma and an aberrant pancreas (Heinrich-I).