胃カルチノイドの4症例

Four Cases of Gastric Carcinoid

　カルチノイド腫瘍の組織学的な最初の記述は，1808年Merlingによる虫垂と小腸の嗜銀性腫瘍に関するものであるといわれる．その後1888年にLebarschはこの腫瘍がLieberkühn腺の腺窩から生ずることを指摘し，さらに，1897年Kultschitzkyによりクローム親和性細胞（Kultschitzky細胞）に由来する腫瘍であることを示した．GossettとMassonはこの細胞中に多数の嗜銀性顆粒がふくまれているという特徴を示し，嗜銀性細胞（argentaffin cell）と称し，それ故，カルチノイド腫瘍はargentaffinomaともいわれた．

　カルチノイドという言葉は1907年Oberndorferによるもので，癌類似の組織像を有しているが性格的にはむしろ良性のものであることから命名されたものである．さらにこれが内分泌性のホルモン産生性腫瘍であることに光をあてたのは，1952年ErspamerとLembeckで，Kultschitzky細胞からセロトニンが分泌されることを示したときにはじまり，Page，Corcoran，Udenfriendらはセロトニンの代謝産物である5-hydroxy-3-indole acetsic acid（5-HIAA）の尿中濃度の上昇が，この腫瘍の存在のよい指標となることを示した．

　In Taiwan reports of gastric carcinoid have been so few and far between that we are not still in a stage to discuss its characteristics encountered in this country. We believe that our personally experienced cases of carcinoid of the stomach do not represent this neoplasm in this country, but 4 cases we have come across since Dec. 1973 are shown here in the sense of comparing them with those reported in Japan.

　Case 1 is a 50-year-old man complaining of hematemesis who had heart-burn and pain in the epigastrium of 10-year duration. Both roentgenography and endoscopy of the stomach led us to a diagnosis of Borrmann Ⅱ type advanced carcinoma on the lesser curvature of the pyloric antrum. As this was further confirmed by biopsy, he was operated on. Histologically, the lesion was gastric carcinoid belonging to B＋C type according to Soga's classification. There was metastasis to regional lymph nodes, but not to the liver.

　Case 2 is a man with hemetemesis and melena and case 3 likewise a man with epigastric pain over the past 3 years. Both were diagnosed as Borrmann Ⅱ type advanced carcinomas, one on the posterior wall of the pyloric antrum in the greater curvature side and the other in the lesser curvature at the level of the angulus. They protruded from the mucosal surface with large ulceration. Histologically, the lesions were both Carcinoid, belonging to Soga's B＋A＋C and B＋C types, respectively. Case 4 is a man 53 years of age, for whom emergency operation was done under a suspicion of perforated gastric ulcer entertained by sudden onset of abdominal pain. Histologic examination of the excised specimen showed that the tumor was gastric carcinoid of C＋B type. None of the cases exhibited Carcinoid syndrome. Metastasis was limited to the regional lymph nodes in all but the case 4 which was free from it.