Linitis plastica様拡がりを示した局所再発小胃癌の1例

Local Recurrence of Minute Cancer of the Stomach, Histologically Showing Spread of Linitis Plastica Type, Report of a Case

　胃癌の中でlinitis plasticaは特異な拡がりを示す1つの型で，その予後はきわめて不良である¹⁾．早期に発見し治療するためにはlinitis plastica typeの癌の初期像およびその原発部位ならびにその進展様式に対する検討^2)～7)が必要である．われわれは，胃角部のⅡcで手術を施行した例において，胃角部のそれとは別に胃体部前壁の噴門側断端近傍に小さな癌巣が発見され，術後2年3カ月たって残胃に再発し，linitis plastica様進展を示した症例を経験したので報告する．

　Thirty-three years old female was diagnosed as having Type IIc＋III of stomach cancer, and partial gastrectomy with Billroth I anastomosis was successfully performed at the Cancer Institute Hospital.

　The resected stomach was histologically examined by complete sections of the specimen.

　The carcinoma preoperatively diagnosed was situated at the antrum through the lesser curvature site, and measured about 2.5×2.5 cm in dimensions.

　Histological examination revealed mucocellular adenocarcinoma limited to the mucosa.

　In addition, another carcinoma measuring about 0.8 cm in the largest diameter was incidentally revealed at the anterior wall of the corpus near the oral surgical end.

　The latter carcinoma, retrospectively ascertained as type III＋IIc, showed scirrhous infiltration of the submucosa. Its surgical end was invaded by several cancer cells.

　Since the carcinoma was completely surrounded with the fundic gland mucosa without intestinal metaplasia, it was clear that the carcinoma arose from there.

　The patient has clinically had remission during two years after the operation. However, local recurrence was found by endoscopic examination.

　Resection of the remnant stomach revealed histologically diffuse cancerous infiltration of the submucosa of the anterior wall, while the involvement of the mucosa and submucosa was limited to the sutured area between the anterior and posterior walls.

　Dimensions of the submucosa and mucosa infiltrated with cancer cells were about 8.0×5.5 cm, and 1.0×1.5cm, respectively.

　The submucosa infiltrated with cancer cells showed moderate fibrosis. Accordingly, the local recurrence of the remnant stomach showed spread of linitis plastica type.

　Histogenesis of the small carcinoma and morphogenesis of linitis plastica, and detection of the oral surgical line are briefly discussed.