8多発早期胃癌の1例

Eight Early Gastric Cancers, Report of a Case

　多発早期胃癌はそうまれなものではないが，病巣数が多くなるほど出現頻度は低くなる．

　最近，著者らは8個のⅡc病巣から成る1例を経験した．併存病巣として2個の異型上皮巣，1個の良性潰瘍瘢痕が見られた．このような8個の病巣から成る多発早期癌はまれで，病巣数が多くなるほどその術前診断は困難となる．本症例においては8個中6個の癌と1個の異型上皮巣は生検により診断しえたが，残りの病巣は術後の検索により発見された．

　Eight Ⅱc type early gastric cancers, complicated with 2 atypical epithelium and a benign ulcer scar found in a 60 year-old man are reported.

　Cases of multiple early gastric cancers resected during the past 16 years in National Sapporo Hospital, are 20 among 305 cases of early gastric cancers (6.6 %). Therefore they are not so rare. But those with more multiple lesions are rare. Moreover, the more multiple and smaller they are, the more difficult they are to diagnose, although the method of detection of gastric cancers has markedly progressed.

　Before operation, 6 among 8 cancers were diagnosed by endoscopic biopsy in this patient. These cancer lesions had various measurements, from 5 mm to 15 mm in the maximum diameter.

　It is believed not so difficult to find the 2 overlooked lesions in resected gross specimen, which is the point to reflect.

　Microscopic appearance of cancers showed well differentiated adenocarcinomas in 7 lesions and moderately differentiated adenocarcinoma in another.

　The mucosa surrounding cancers showed intestinal metaplasia which had goblet cells almost without Paneth cells.

　Also was found epitheloid cell granuloma with infiltration of histiocytes, which was located in the mucosal and submucosal layer in the section of the most oral cancer (lesion No. 1). The cause of granuloma is not clear yet.

　This patient had been a heavy drinker and smoker. And his brothers died of gastric cancer and esophageal cancer respectively. In addition, such extrinsic or intrinsic factors possibly relate to the growth of cancer in this patient.