種々の発育相を呈した多発性胃カルチノイドの1例

Multiple Carcinoid Tumors of the Stomach Showing Various Stages of Development, a Case Report

　胃生検により診断し，病理組織学的に興味深い胃カルチノイドの多発症例を経験したので報告する．

　A case of three independent carcinoid tumors of the stomach is described. The patient, a woman 69 years of age, had noticed since three years before a tumor in the upper part of the abdomen. It was with a chief complaint of hematemesis that she visited the hospital. Preoperative diagnosis of gastric carcinoid was established by biopsy. Prior to surgical intervention there was on increase of 5-HIAA in the urine or of 5-HT in the blood.

　Subsequent to cardiectomy the excised specimen revealed three carcinoid lesions in the cardiac segment. The lesion A, measuring 3.5×2.5×2.5 cm, was localized in the submucosal layer and was lobulated. The lesion B, measuring 0.5×0.5×0.1 cm, was shaped like a dumbbell straddling the mucosal and submucosal layers. The lesion C, 0.4×0.4×0.2 cm in dimensions, was limited within the mucosal layer. Histologically three lesions were fundamentally of the same nature, showing various arrangement of cell nests that consisted of uniform cells with small almost round nuclei of very limited atypicality. We arrived at a diagnosis of carcinoid tumors of the stomach. The cells were positive for argyrophil reaction and negative for argentaffin reaction.

　These three lesions each in a different stage of development seem to suggest possible patterns of histologic development of gastric carcinoid:

　1. Carcinoid develops in the mucosa.

　2. In early stage of development it spreads to the submucosa.

　3. Most of Carcinoid tumors clinically managed show characteristics of submucosal tumor.

　Effectiveness of gastric biopsy is emphasized with some reference to the literature on multiple Carcinoid tumors of the stomach.