胃肉腫の病理

Pathology of Gastric Sarcoma

はじめに

　胃に生ずる肉腫は，一般に知られているものでは悪性リンパ腫（細網肉腫，リンパ肉腫，ホチギン病）と滑平筋肉腫がもっとも多く，その他，稀に報告されるものとして，神経性，血管性，脂肪性肉腫などがある．

　悪性リンパ腫と滑平筋肉腫で代表される胃肉腫の胃悪性腫瘍に占める頻度は1～4％前後である．国立がんセンターで7年間に手術（試験開腹を含む）された胃肉腫は32例で，この間に手術された胃悪性腫瘍は1,600例をかぞえるので，その頻度は2％近くである．

　32例の胃肉腫のうち，悪性リンパ腫はやや多く18例，滑平筋肉腫は14例であった．

　今回は悪性リンパ腫と滑平筋肉腫の臨床と病理の問題点に触れ，その他の稀な肉腫については他の機会に譲ることにする．

　1) Cases of gastric sarcoma operated on in the National Cancer Center Hospital for the past 7 years, amount to 32, comprising about 2 per cent of 1,600 all other cases of malignant tumors of the stomach surgically treated in the same period. Thirty two cases of gastric sarcoma include 14 cases of leiomyosarcoma and 18 malignant lymphoma. No other variety of sarcoma. has been encountered.

　2) Of 14 cases of leiomyosarcorna of the stomach the male predominated a little over the female, the former being 8 cases and the latter 6. The average age was 60. Its mean size was 7.0 cm in the greatest diameter, and there were 9 cases with ulceration on the surface. Macroscopically classified, 4 were endogastric, 1 was intramural and 9 exogastric. Liver metastasis was found in 5 and of these 4 were exogastric associated with ulcer formation. For estimation of the prognosis, histological measument of mitosis is of great. In all fatal cases with liver metastasis, the mean value of number of mitosis was higher than in non-fatal ones.

　3) Of 18 cases of malignant lymphoma of the stomach, 13 were operated On with success and 5 had only experimental resections. It was more frequent in the male, being 12 cases and the female 6. The average age was 56. Histologically, 11 belonged to reticulum cell sarcoma, 4 to lymphosarcoma and 3 to Hodgkin's disease. Malignant lymphoma is macroscopically classifecl into 4 types; protruding, ulcerative, superficially infiltrative and giant rugal ones. Any single type of malignant lymphoma was seldom encountered. Coexistence of various types was more frequent. As for its prognosis, lymph node metastases were found in 10 out of 18 and 5 cases were fatal. It is more favorable when there has been no lymph node metastasis, or it has been localized in the regional nodes. In cases of lymph node metastasis to the abdominal cavity or when they were systemic, all ended fatal.