粘膜内癌と細網肉腫の同一胃内共存例

Independent Coexistence of Mucous Carcinoma and Reticulosarcoma in the Same Stomach

はじめに

　本邦においては臓器別の悪性腫瘍の発生率は消化管に最も高く，なかでも胃癌は圧倒的多数を占めている．しかし，同一胃のそれぞれ異なった部位に生じる重複胃癌は比較的稀である．胃癌に較べると，悪性リンパ腫をはじめとする平滑筋肉腫などの非上皮悪性腫瘍の発生は低率で，さらには癌腫と肉腫の全く異なった性格の2病変が何の連絡もなく，個々に独立して同一胃に共存する場合は非常に稀である．私共は最近，同一胃に悪性リンパ腫（細網肉腫）と粘膜内癌とが独立して別個に共存した症例を経験したので，文献的考察を加えて報告する．

　A case of independently coexisting mucous carcinoma and malignant lymphoma (reticulosarcoma) was recently encountered in a 62-year-old woman. Two tumors of such dissimilar pathogenesis arising in the same stomach are extremely rare. As far as we have been able to find out both abroad and at home, only nine cases have been reported so far.

　The mucous carcinoma was overlooked by various preoperative examinations, and a huge area of sarcoma, later identified as malignant lymphoma by the cytodiagnosis of the direct smear during operation, was mistaken for that of carcinomatous origin. The mucous carcinoma, measuring 0.8×0.9 cm, was located on the lesser curvature of the antrum, while sarcoma was situated on the greater curvature, extending over to both walls of the fundus. Cells characteristic of respective lesions could not be obtained by the Kimopsin lavage method.

　When examining multiple lesions in the stomach, one should always bear in mind the possibility of concomitant growth of carcinoma and sarcoma as seen in the present case. Much is still to be expected from cytology and biopsy that make it possible to differentiate essentially between epithelial and non-epithelial cells. Increase in the detection of such cases is anticipated in accordance with the improvement in diagnostic techniques.