術前に診断した胃カルチノイドの1例

A Case of Carcinoid of the Stomach

はじめに

　カルチノイドは，セロトニンを分泌する内分泌腫瘍として知られ，主に消化管に発生し，稀ではあるが，気管支，膵，上顎洞，卵巣，胆嚢にも発生する．

　胃のカルチノイドは，稀な疾患ではあるが，Askanazy（1923）¹⁾の剖検による偶然の発見以来，1961年までに84例を数えるという²⁾．

　筆者らは，昨年も，X線，内視鏡にて胃粘膜下腫瘍として胃切除を行ない，病理組織学的に胃カルチノイドと診断した症例を報告した³⁾．

　その後，術前X線および内視鏡所見より，胃カルチノイドを疑い，胃生検所見と合せて胃カルチノイドと診断した1例を再度経験したのでここに報告し，その診断面について若干の考察を加えてみたい．

　なお，本症例は胃原発カルチノイドの本邦第11例目にあたる症例報告と思われる．

1) A case of gastric carcinoicl is described which was first preoperatively suspected as such by x-ray and endoscopy and later accurately diagnosed by histological pictures of biopsied specimen taken under endoscopical guidance.

2) The patient, a 71-year-old male, had no “carcinoid syndromes” and 5-H. I. A. A. in the urine remained within normal limits. No metastasis to other organs was recognized.

3) Gross specimen of the resected tumor showed that it was a submucosal tumor on the greater curvature side of the corpus with an ulcer on its top. Its size was 2.5×2.0×0.7cm.

4) The cut surface was comprised of structures of several colors: yellowish white, grayish white and brown. They were relatively well demarcated from one another.

5) Histopathologically, the tumor was divided into different cell patterns: a portion in which cells were arranged in small cords or ribbons (a); one where cells were slightly atypical (b); a part where cell atypicality was prominent associated with mitotic figures (c); rosette-like structure (d); glandular structure (e) and grouping of cells rich in eosinophile cytoplasm (f).

6) Argentaffin cell stain by Fontana's and Sevier-Munger's methods was positive in the parts (a) and (d). It was negative in the others.

7) Review of the literature from the stand point of carcinoid diagnosis shows that gross appearance of the tumor as well as quantitative measurement of 5-H. I. A. A. in the urine is not of great help in its diagnosis. Biopsy under the guidance of endoscopy is greatly conducive to its correct diagnosis. However, as pointed out by Bochus, the existence of intramural carcinoma must always be borne in mind.