早期胃癌と合併した胃平滑筋肉腫の1例

Independent Coexistence of Early Cancer and Leiomyosarcoma in the Stomach: A Case Report

　一般に胃腸管系に発生母地の違った悪性腫瘍が共存することは極めて稀である．最近，我々は臨床的にボールマンⅠ型の胃癌の診断のもとに胃切除術を行った症例に，噴開部から胃底部にかけて平滑筋肉腫と，それとは独立して体部後壁にⅡc型早期癌とが共存した非常に稀な1症例を経験したので報告する．

症例

　患　者：42歳　男　会社員

　主　訴：えん下困難

　家族歴・既応歴：特記事項なし

　現病歴：1973年8月ごろより物を食べると呑込みにくくなったり，また腹部膨満感が時々あるも放置していた．しかし前記症状が1974年3月ごろより次第に強くなったので同年5月当科を受診した，なお，上腹部痛，下血等の胃腸症状はなかった．

　入院時現症・検査所見：体格中等度で栄養状態は可．眼瞼結膜および球結膜に貧血，黄疸はなし．頸部および鎖骨上窩リンパ節は触知しない，心肺は特に異常なし．腹部は平坦で圧痛などもなく肝，脾腫もなし．腱反射は正常．血圧120-70mmHg．尿検査は正常．便潜血反応は陰性．赤血球418万．Ht38％，Hb129/dl．白血球8,700．肝機能はほぼ正常．梅毒反応は陰性．胸部レ線およびECGには異常なし．血沈1時間値17mm．

　A case of independently coexisting early adenocarcinoma and leiomyosarcoma was observed in the stomach of a 42-year-old man. The patient was admitted to our hospital because of dysphagia. X-ray photographs of the stomach revealed a large tumor of Borrmann type I of gastric cancer in the cardia, and also an erosive lesion on the posterior wall of the corpus near the lesser curvature. On resected specimen, the large tumor, which was diagnosed preoperatively as Borrmann type I was leiomyosarcoma (11×12 cm in diameters) with central ulceration showing that similar findings to those seen in leiomyoblastoma were present in some part of the tumor. There was also found intramucosally a poorly differentiated adenocarcinoma in the posterior wall of the corpus near the lesser curvature, which was Ⅱc type of early cancer (1×0.7 cm in diameters), independent of aforementioned sarcoma. The patient died ten months after operation in cachectic condition.

　Autopsy showed severe metastasis of leiomyosarcoma in the liver, but nowhere was observed the metastasis of adenocarcinoma of the stomach.