孤在性脳実質内転移をきたした下部食道噴門癌の1例

A SOLITARY INTRACEREBRAL METASTASIS OF GASTRIC CANCER: REPORT OF A CASE

緒言

　転移性頭蓋内腫瘍中，肺癌は，ほとんどの例が血行性に転移を来たし，脳実質内腫瘍の型をとる。一方，胃癌の場合はリンパ行性に「びまん性髄膜転移癌腫症」（dif—fuse meningeal carcinomatosis）の型をとり，血行性に弧在性または多発性の脳内癌結節をつくることは極めて稀とされ，所^1）は，400例の胃癌剖検例中脳転移を来たした7例全てがびまん性脳膜転移の型をとり，ついに胃癌の結節性脳実質内転移は1例もみられなかつたとのべている。

　最近，われわれは弧在性脳実質内腫瘍を摘出したところ，組織学的にadenocarciomaで，精査の結果肺にはレ線上転移巣を認めず，原発巣が下部食道噴門癌であることが判明し，改めてこれに対する根治的手術を行なつて全治退院せしめえた稀な症例を経験したので報告する。

Metastatic route of gastric cancer to the intra-cranial space is believed to be lymphogenic. There-fore, its metastatic lesion takes a form of diffuse meningeal carcinomatosis, and a metastatic intra-cerebral tumor of gastric cancer has seldom been encountered.

Recently we experienced a rare case of 52-year-old male in which solitary subcortical tumor in the left parietoccipital region was removed and histology revealed adenocarinoma. No meningeal changes were noted at the time of operation. Posto-perative complete work up revealed the primary focus to be gastric cancer. Radical operation for gastric cancer was performed. In the follow-up, the patient has been doing well.

In this case, an intracerebral metastatic lesion was detected first. Radical gastric operation was performed thereafter. It is noteworthy that gastric cancer has a potency of hematogenic metastasis to the intracranial space, even if it is quite a rare occasion.