男子胃にみられた悪性絨毛上皮腫と腺癌の合併した1例―その文献的考察

Coexistence of Chorionepithelioma and Carcinoma in the Stomach of a Man: Case report and review of the literature in the male subject

　性器外に原発する悪性絨毛上皮腫（以後絨腫と省略）は癌，肉腫等の他の悪性疾患に比べればはなはだ稀なものといえよう．これらのうち胃原発の絨腫となるとさらに少なく，ほとんど経験する機会にめぐまれない．一方，絨腫は極めて転移をきたし易く，特に女子では分娩¹⁾，流産，胞状奇胎等²⁾³⁾に，男子では睾丸腫瘍⁴⁾⁵⁾に続発したものがあり，これらとの鑑別が実際にはなかなかむずかしいことが多い．しかし転移性絨腫を例にとっても胃に転移するのは非常に少ないといわれている⁶⁾⁷⁾．最近われわれは45歳，男子胃に絨腫と腺癌を合併した1例を経験した．そこで分娩，流産，胞状奇胎などの機会の多い女子例を除外し，胃およびそれに近接した大網に発生した男子絨腫例について少しく文献的考察を加えて報告する．

　Primary extragenital chorionepithelioma arising in the stomach and omentum in the male subject is a very rare malignant tumor. We had a chance to operate on a patient with chorionepithelioma and adenocarcinoma of the stomach. A man, age 45, was admitted to our clinic on June 2, 1975, complaining of general fatigue and epigastric distress. Investigatigation showed a filling defect from the antrum to the corpus of the stomach. A scintigram test revealed multiple metases of the liver. In addition to gynecomastia, a pregnancy test was positive, but the testes were normal.

　Under the diagnosis of gastric sarcoma an operation was performed on June 12, 1975. The tumor involved the antrum and corpus of the stomach. Also present were multiple liver metastases. Consequently, a palliative total gastrectomy with splenectomy was performed. Microscopic findings in the stomach revealed the coexistence of chorionepithelioma and adenocarcinoma. Convalescence was uneventful and the patient had a few fairly normal days, but he died of cachexia 84 days after the operation. The autopsy was limited to a liver biopsy and an orchiectomy. Microscopic examination demonstrated characteristic chorionepithelioma of the liver, but the sections of each testis failed to show evidence of a tumor.

　Eighteen similar cases (present case included) have been found in the literature and a summary is as follows: Fifteen cases coexisted with chorionepithelioma and carcinoma in the stomach, and a gonadotrophic hormon test was recorded in only 5 out of 18 cases, each reportedly positive. The distribution of patients by age at the time of diagnosis is presented in Table 1. Fourteen patients were in their forties, fifties or sixties. Location of the primary tumor was antrum in 10 cases and cardia in four.

　Metastasis, described in 17 patients, was commonly involved with the liver, lung and regionary lymphnodes. The state of the testis was mentioned in 16 patients. Clinicaly all testes were normal. The state of the breast wes mentioned in only four patients. One had a normal male structure, another three had a gynecomastia.