早期胃癌再発症例

A Report of a Case of a Recurrent Cancer in a Post-Operative Stomach after Six Years of Resection of the Type I Early Cancer

Ⅰ．症例

　患者：63歳男職業農業

　初回手術時臨床所見

　主訴：心窩部重圧感

　現病歴：40歳頃より食後心窩部に重圧感があり，またときに空腹時に腹痛もあった．そのほか自覚症状はなかった．昭和37年10月胃集団検診をうけ，要精検といわれ，千葉大学第1内科で精密検査をうけ，ポリープ癌（早期胃癌の疑い）と診断され，同年11月28日綿貫外科に入院した．

　The subject is a farmer (male) 63 years of age. At a mass survey done in October, 1962, he was told that he needed a close examination, and received it at the First Department of Medicine, Chiba University. His lesion was diagnosed as a Type I early cancer (polyooid cancer), and on 4 th December, 1962 gastrectomy was performed. The pathological finding of the resected specimen was adenocarcinoma papillotubulare. It was an early cancer with infiltration limited to the mucosa. The metastasis of the lymphgland could not be seen, and radical resection was completed.

　In around October, 1968, six years after the operation, he visited our hospital with chief complaints of decrease of appetite and dysphagia. The x-ray and the gastrocamera examinations revealed a postoperative gastric cancer. On 14 th January, 1969, the simultaneous resections of the postoperative stomach, spleen and tail of the pancreas were performed. The infiltration, recognized in the whole area of the gastric remnant, reached the serosa. No metastasis of the liver existed. The metastasis of the lymphgland was recognized at the hilus of the spleen and around the cardia. The macroscopical finding was a gastric cancer, Borrmann's type Ⅳ and adenocarcinoma tubulare. the deep infiltration reached the serosa. The post operation course was favorable, and he left the hospital. About six months later, however, the swelling-up of the liver and the accumulation of ascites were recognized, and he died on 10th August of the same year (1969).

　Recurrent patterns of early gastric cancer are mostly observed at the stoma with its infiltration, and remote metastases are caused by vascular invasions. However, the fact that the case reported here cannot be included in either of these with its histopathological fiindings being of different features in their details seems to indicate that an independent primary tumor arose in the gastric remnant. It is thus of interest both clinically and carcinigenically.