広範な微小肝転移を認めたsporadic type胃カルチノイドの1例

Sporadic Gastric Carcinoid with Multiple Micrometastases in the Liver, Report of a Case

要旨　患者は64歳，男性．高血圧で通院中，胃内視鏡検査で胃体上部後壁に不整な陥凹性病変を認め，生検の結果はカルチノイドであった．超音波内視鏡検査で腫瘍は胃壁全層に浸潤すると診断し手術を行った．病変の大きさは割面で20mmであった．肉眼的には粘膜下に浸潤したⅡc進行型胃癌様であったが，組織学的には漿膜に浸潤した古典的カルチノイド腫瘍で，リンパ節転移を認めた．術中，肝臓は脂肪肝様に軽度腫大していたため生検を行った．採取した肝組織に微小肝転移を2か所に認めた．比較的小さいにもかかわらず高度の転移能を有したsporadic typeの胃カルチノイドを報告した．

　The patient was a 64-year-old male. Under treatment for hypertension, routine endoscopic examination showed an irregular depressed lesion on the posterior wall of the upper gastric body. Biopsy diagnosed it as a carcinoid tumor. Endoscopic ultrasonography showed the tumor infiltrating throughout the entier gastric wall, so a surgical operation was carried out. The size of the tumor was 20 mm in diameter inside the wall. Though it was macroscopically suspected as a Ⅱc-like advanced cancer invading to the submucosa, histologically it was a classical carcinoid tumor with invasion to the serosa and multiple lymphnode metastases. Later, two other micrometastases were found in the liver tissue resected for biopsy during the operation. In spite of its relatively small size, the lesion was highly metastatic, so it is reported as a case of gastric sporadic carcinoid tumor.