緩和手術後に診断された胃原発絨毛癌の1例

Primary Gastric Choriocarcinoma Diagnosed after Palliative Gastrectomy, Report of a Case

要旨●患者は60歳代，男性．貧血を契機に遠隔転移を有する進行胃癌と診断した．一次治療開始後に原発巣からの出血による貧血が進行し，緩和照射を行った．一次治療で奏効が得られたが，約7か月後に肝転移が増大し二次治療へ移行した．しかし，間もなく原発巣からの出血が制御できず緊急入院となり，緩和手術として胃全摘術を施行した．病理組織学的診断では，腫瘍細胞は好酸性で多核の合胞体栄養膜細胞様のものと，淡明な細胞質を有する細胞性栄養膜細胞様のものが混在していた．これらは免疫組織化学染色でhCG陽性であり，胃原発絨毛癌と診断した．術後，急速な肝転移の増悪による肝障害を認め，術後28日目に原病死となった．

　We report the case of a man in his 60s who was diagnosed with advanced gastric cancer with distant metastasis. Since anemia due to continuous bleeding of the primary lesion progressed, palliative irradiation was performed. Seven months later, the number and size of liver metastases increased despite second chemotherapy. He underwent total gastrectomy as palliative surgery because tumor bleeding could not be controlled. Histopathology revealed a mixture of eosinophilic, multinucleated, syncytiotrophoblast-like, and cytotrophoblast-like tumor cells with pale cytoplasm. These cells were positive for human chorionic gonadotropin on immunohistochemical staining ; thus, the patient was finally diagnosed with primary gastric choriocarcinoma.