治癒切除後，腹膜播種を来し1年3ヵ月後に再発死亡したⅠ型早期胃癌の1例

Early Gastric Cancer, Type Ⅰ (sm), with Peritoneal Dissemination Fifteen Months after Operation, Report of a Case

要旨　体重減少（10kg/年）を主訴にした81歳の男性で，術前胃X線検査および内視鏡検査で1型早期胃癌と診断され，1982年4月9日に胃亜全摘術が施行された．肉眼所見では，小結節状凹凸のある7.0×3.0cmの隆起性病変であった．組織学的には，高分化型管状腺癌と一部に印環細胞癌と膠様腺癌がみられた．深達度はsm，脈管侵襲陽性で，転移は小彎リンパ節（No.3）に認めた．術後約4カ月ごろよりイレウス症状が時々あり，同年11月28日に手術を行い，腸間膜組織とリンパ節を生検した．それらの組織学的検査で転移を認め，リンパ管侵襲とリンパ節転移を伴う腹膜播種再発と診断された．化学療法（FT 207）にもかかわらず，Schnitzler転移，腹部腫瘤，腹水を認めるようになり，初回手術後1年3カ月で死亡した．Ⅰ型sm胃癌でありながら腹膜播種により再発死亡した．これはリンパ管侵襲とリンパ節転移を介しての腹膜播種と考えられた．

　An 81 year-old man with complaint of weight-loss (10 kg/year) was diagnosed preoperatively by upper GI series and endoscopy to have type I early gastric cancer. Gastrectomy was performed on April 9, 1982. Macroscopically, the tumor was a protruded lesion measuring 7.0×3.0 cm, and had an erosive area with mucoid degeneration on the anterior wall. Histologically, the tumor consisted mainly of well-differentiated adenocarcinoma in the mucosa and partly mucinous adenocarcinoma with signet-ring cell carcinoma which massively invaded the submucosa at the anterior wall portion. Lymph node involvement was found in two nodes of the lesser curvature group (No.3). The postoperative course was good, but the patient sometimes presented ileus symptoms since about four months after operation. Jejunal lysis for ileus and biopsy of the mesenterial lymph node and scar-like tissue was done on December 28, 1982. Microscopically, it was proved to be peritoneal dissemination and lymph node metastasis. In spite of the anticancer chemotherapy (FT 207) the patient died of cancerous recurrence (peritoneal dissemination) fifteen months after the first operation.