多彩な病変を伴う10多発胃癌の1症例

A Case of 10 Cancers in the Stomach with Various Lesions

　胃疾患診断技術の進歩と詳細な病理組織学的検討とが相まって，多発胃癌の報告例も次第にふえてきている．ことに最近では，多発早期胃癌症例の報告に接する機会がしばしばである．著者らは切除胃の病理組織学的検討により，1個の進行癌と9個の早期癌，2個の異型上皮，副膵およびびらんを同一胃内に確認した興味ある1症例を経験したので報告する．

　Multiple gastric cancers were first reported by Barth in 1855. Since then there have been many reports, both at home and abroad. The authors have recently performed R₂ subtotal gastrectomy in a man 50 years of age with a chief complaint of loss of appetite after a diagnosis of multiple cancers of the stomach had been made by X-ray, endoscopy and biopsy. Histologic examination of the resected stomach revealed one advanced cancer and 9 early cancers. They were all considered independent lesions because there was no histologic continuity nor was any intravascular invasion recognized. Gross findings of each cancer were as follows: 1 IIc-simulating advanced cancer, 1 IIb, 5 IIa＋IIc, and 3 IIc. Histologically they were all signet ring cell carcinomas, a fact consistent with what other authors had described: each of multiple gastric cancer looks alike macroscopically. In histologic types too, all of them belong either to the same variety or to other similar types. Raletionship between the multiple carcinomas and concomitant ATP or aberrant pancreas found in this case is not clarified yet, but it is pregnant with many interesting problems. The incidence of more than 5 multiple cancers is low. A case of 10 multiple cancers is considered of extremely rare occurrence. Further, this case is of great significance in the study of mechanism of evolution in multiple cancers.