胃粘膜内癌が広範囲なリンパ節，骨髄，卵巣に転移し，PTTMで死亡した1例

Early Gastric Carcinoma with Widespread Metastasis and Pulmonary Tumor Thrombotic Microangiopathy (PTTM), Report of an Autopsy Case

要旨　呼吸不全で発症し原因不明の肺高血圧症と右心不全を伴って発症後約8か月で死亡した症例を経験した．患者は29歳の女性で妊娠18週であった．剖検したところ，胃角部前壁の20×20mm大の粘膜内癌と広範囲なリンパ節，骨髄，卵巣に転移が認められた．肺転移はなかったが，両側全葉の小～細動脈に腫瘍塞栓の多発と血管内膜の著明な肥厚による高度の狭窄が認められ，いわゆるpulmonary tumor thrombotic microangiopathy(PTTM)が直接死因と考えられた．本症例はm癌の遠隔転移例である点，およびPTTMを合併している点で稀有な例であるが，転移とPTTMの責任因子を解明する目的で癌細胞のestrogen receptorとtissue factorの発現を免疫組織学的に検討した．しかし両者とも染色陰性であった．

　A twenty nine-year-old woman was admitted to the hospital for progressive respiratory distress. She died from pulmonary hypertension and right heart failure about 8 month from the onset. She was 18 weeks of pregnancy at the time of death. Autopsy revealed a 20×20 mm-sized early gastric carcinoma, (0 Ⅱc＋Ⅱa m, sig, 1y₁, v₀, INFβ) which metastasized to lymph nodes in various areas, bone (lumbar and thoracic, examind), and both ovaries. Although neither parenchyma nor interstitium of both lungs was not involved by metastatic cells, there were multiple fresh infarctions in entire lobes of the both lungs resulting from tumor emboli mainly in the small pulmonary arteries with striking fibromuscular thickening of the intima. Morphology of the vascular changes was consistent with that of pulmonary tumor thrombotic microangiopathy (PTTM) and was considered to be the direct cause of the death of this patient. To evaluate factors affecting the pathogeneses involved in strong metastatic potential of the carcinoma and PTTM, we performed immunohistochemical studies on expressions of estrogen receptor (ER) and tissue factor (TF) using monoclonal antibodies but no positive signs for both antibodies were observed.