胃迷入膵より発生した胃癌の1例

Carcinoma Originating from the Heterotopic Pancreas in the Stomach, Report of a Case

　われわれは胃迷入膵から生じたと思われる癌の1症例を経験した．これまでに，正確に記述されたこのような症例の報告数は国内・外ともに極めて少なく，貴重な1例と思われるので報告する．

　A 44-year-old woman without subjective complaints had an x-ray examination for gastric mass survey in July 1980. A shadow defect was found in the greater curvature of the antrum. A closer x-ray examination revealed a large and protuberant lesion on the greater curvature of the antrum. Gastrofiberscopic examination showed a tumor covered with smooth mucosa, but the surface of the tumor was uneven and reddish in part. Specimens from the surface contained no neoplastic cells histologically. A large cyst was detected in the tumor by ultrasound sonography, abdominal CT scan and celiac angiography. In spite of the doctor's persuasion, the patient refused the subsequent operation.

　Five months later, she complained of epigastralgia and anorexia, and then underwent subtotal gastrectomy on February 13, 1981. Macroscopic examination of the resected stomach revealed an extramural cyst and intact mucosa overlying the tumor with a few small ulcers. The tumor consisted of papillary cystadenocarcinoma with a proliferation of smooth muscles and connective tissues in the stroma. Pancreatic tissues were also found in contact with the tumor and moreover, appeared to be converted into the malignant cells. These clinical and histolgical observations suggest that the papillary cystadenocarcinoma may have originated from the heterotopic pancreas in the stomach (Heinrich-Ⅱ type).