胃のいわゆる癌肉腫の1例

So-called Carcinosarcoma of the Stomach, a Case Report

　Carcinosarcomaは，いまだ混乱した，議論の多いentityである．同一腫瘍内にepithelial（carcinomatous）およびnon-epithelial（sarcomatous）の両組織成分を混ずる悪性腫瘍に名づけられ，稀なものであるが，子宮，呼吸器系，乳腺，食道，甲状腺等によく記載をみる．胃におけるcarcinosarcomaの記載は極めてまれであり，Tanimura and Furuta¹⁾によれば，1904年のQueckenstedtの第1例報告以来，1967年の彼らの報告を含め24例を数えるにすぎない．24例中14例は本邦例である．しかし，この24例の収載にはcollision tumorも含まれており，carcinosarcomaに対する考えいかんによっては，より少数となり，あるいは胃に関してその存在自身も疑われさえする．著者らの経験した胃のいわゆるcarcinosarcomaの1例を報告し，検討を加えたい．

　The case: a 69-year-old woman complaining of pain in the epigastrium, melena and weight loss, accompanied with a high degree of anemia. As roentgenograms demonstrated a large protruding tumor in the center of the anterior wall of the pyloric antrum, she underwent partial gastrectomy. During surgical intervention a number of swollen regional lymph nodes were seen together with a metastatic tumor the size of a walnut in the left lobe of the liver. The partially excised stomach revealed a large elevated tumor as was seen in X-ray, measuring 9.2×7.5×5.0 cm, in the same site demonstrated by X-ray. The base of the raised margins of the tumor was constricted.

　Histologically, the upper part of the tumor showed mostly a sarcomatous picture, while the base and the skirt of the neoplasm consisted of well differentiated adenocarcinoma, invading as far as the serosa. The superficial part was accompanied with erosions and marked inflammatory cellular infiltration. The border between the area of cancer and sarcomatous part was irregular, intermixing well with each other, in some parts cancer constituting tumor parenchyma and in others sarcomatous part making up the tumor stroma. In sarcomatous part were seen such cells as spindle-shaped or ovoid fibroblastic cells, bizarre, large-typed spindle cells and likewise bizarre giant cells with multiple nuclei or single nucleus. These cells were variously intermixed according to the location examined. Mitotic figures or nuclear hyperchromasia were also well observed. However, contrary to the typical pictures of sarcomas hitherto known, it was hardly possible to regard the sarcomatous part really as sarcoma. It was true that the possibi ity of some variations of cancer cells or their anaplasia could not be ruled out, but we were more of the opinion that the sarcomatous part respresented marked chronic proliferative inflammatory process following erosions and destruction of the upper parts of polypoid cancer. Metastases were seen in six lymph nodes out of six, all due to differentiated adenocarcinoma.

　The patient died of hepatic failure about six months after the operation. Autopsy was not permitted.

　Historical transition in the concept of carcinosarcoma has also been mentioned briefly with quotations from the reported cases of gastric carcinosarcoma and with some reference to its literature.