同一胃に進行癌と肉腫が独立して併存した症例

Independent Coexistence of Advanced Cancer and Leiomyosarcoma in the Same Stomach

　胃癌と胃肉腫の合併例は非常に稀とされている．最近，われわれは胃角部にBorrmann 3型進行癌，胃体部小彎に平滑筋肉腫を併存した例を経験したので文献的考察を加えて報告する．

　A 44 years old male visited our clinic complaining of hunger epigastralgia of six months' duration. Double contrast picture in the supine left anterior oblique position revealed a shallow barium fleck on the posterior wall at the angle with converging folds, which had hypertrophy of their tips. A well-defined elevated lesion with an irregular central depression was also seen on the lesser curvature of the gastric body in the supine position. Endoscopic examination showed a nodular discolored elevation on the lesser curvature of the body, and a shallow ulcer covered with white coating on the lesser curvature of the angle, independent from each other. Biopsy specimens from the lesion at the corpus were negative for cancer. However, those from the lesion at the angle showed adenocarcinoma tubulare. From these find-ings, the latter was diagnosed preoperatively as IIc-like advanced cancer, which was confirmed postoperatively as Borr. 3 type advanced cancer. Malignancy of the former could not be excluded, however, in spite of benign findings in the biopsy specimens, probably suggestive of leiomyosarcoma because of macroscopic features. Histopathologically, on the resected stomach these two lesions coexisted independently and the one was diagnosed as leiomyosarcoma, and the other adenocarcinoma tubulare. Distance between the margin of cancer and that of leiomyosarcoma was 10 mm. Metastasis of the cancer was found on regional lymphnode, but that of sarcoma could not be detected.