短期間に著明な形態の変化をみた胃細網肉腫とⅡb型早期胃癌の合併例

Primary Gastric Reticulum Cell Sarcoma Associated with Early Gastric Carcinoma Independently, a Case Report

　胃に重複癌の発生をみることはそれほど稀ではなく，われわれの施設でも藤原ら¹⁾によると切除された胃癌の3.2％にみられている．しかしながら発生母地の異なった悪性腫瘍が，同一胃にそれぞれ独立して共存することはきわめて稀である．われわれは最近，比較的短期間に著明な形態の変化を来たし生検にて確診しえた浸潤がsmにとどまる胃細網肉腫と，それと離れた部位に独立して存在していたⅡb型早期癌の合併例を経験したので報告する．

　We have observed a case of primary gastric reticulum cell sarcoma with its invasion localized in the mucosa and submucosa and associated with early gastric carcinoma, so-called IIb type.

　A 49-year-old female visited our hospital with a complaint of hunger epigastralgia. The first gastroendoscopy revealed a large ulcer on the anterior wall of the antrum. The first upper GI series showed a large crater at the same place. The second gastroendoscopy with tissue biopsy revealed a large crater with its base covered with thick creamy coat. The obtained tissue showed marked chronic gastritis. The third gastroendoscopy with tissue biopsy revealed almost the same finding as the first endoscopy. The obtained tissue also showed a same picture as in the previous study. About two and half a month after the first endoscopic study, the 4 th gastroendoscopy with tissue biopsy revealed only multiple ulcers on the antrum and angulus instead of large crater. The biopsy specimens showed picture compatible with reticulum cell sarcoma. The second upper GI series showed converging folds on the posterior wall of the angulus.

　Total gastrectomy was carried out. On the resected specimen, a large crater, most likely Bormann 2 type carcinoma, was seen at the distal half portion. The microscopical examination revealed a picture of reticulum cell sarcoma at this place. Furthermore, well differentiated adenocarcinoma was also found.

　Fourteen cases of coexsistent gastric carcinoma and gastric sarcoma are reported in the literature at present and we have reported the 15th case here.