胃カルチノイドの2例

Primary Carcinoid Tumor of Stomach, Report of Two Cases

　カルチノイド腫瘍は既に1907年にOberndorfen¹⁾が，小腸腫瘍の症例で組織学的に癌に似ているが，臨床的に良性経過をたどる症例に命名したものである．更にMasson²⁾は，この腫瘍の細胞中に銀親和性顆粒の存在を発見し，この細胞をargontaffin cellと呼び，カノレチノイド腫瘍がamentaffinomaともいわれるようになった．われわれは最近胃原発性の2例のカルレチノイド腫瘍を経験し，その1例は過去報告されたことがないほど大きいもので，肝転移をみないが，カルチノイド症候群を呈したので報告する．

　Case 1 was a 30 year-old woman, complaining of epigastric pain ever since a month ago. The radiographic and endoscopic studies of the stomach led us to a diagnosis of benign submucosal tumor on the posterior wall at the antrum near the greater curvature. Enucleation of the tumor was made, measuring 2.8×2.5×2.1 cm. On histological observation the tumor was diagnosed as carcinoid, so that second operation was followed with gastrectomy. No metastasis in the liver and regional lymph nodes was observed. She was free from the disease for 20 months postoperatively.

　Case 2 was a 27 year-old woman, complaining of epigastric pain, and frequent meiena for 3 months duration. The patient showed carcinoid syndrome of facial flushing, palpitation, anorexia and dizziness during her illness. A large Borrmann 3-type advanced carcinoma, on the posterior wall from the body to the antrum of gastric wall with two ulcerations, was observed by radiographic and endoscopic studies. Subtotal gastrectorny was performed. The tumor was carcinoid by histological study and the largest ever reported in Japan. A part of the gastric serosa was invaded by the tumor, and metastasis in regional lymphnodes was observed, but not in the liver. She has been free of recurrence for 24 months postoperatively.

　The levels of serotonin and 5-HIAA in both patients were within normal values at least after operation. It is noteworthy that the case 2 showed carcinoid syndrome even in the absence of liver metastasis.