Nobuhiko Toyota

ADENOSQUAMOUS CARCINOMA OF THE STOMACH ASSOCIATED WITH SEPARATE EARLY GASTRIC CANCER (TYPE IIC)

Adenosquamous carcinoma originating in the stomach is a relatively rare entity. It comprises less than 0.5% of all gastric cancers. Recently, we encountered a patient with gastric adenosquamous carcinoma associated with separate early gastric cancer (type IIc). The patient was a 72-year-old man who was diagnosed as having gastric cancer in a multiphasic health screening examination conducted in May 1992. The patient subsequently underwent pylorogastrectomy. Examination of the resected specimen revealed two lesions, advanced cancer (Borrmann 2) and early cancer (type IIc). The lesions were histopathologically diagnosed as adenosquamous carcinoma and adenocarcinoma, respectively. The majority of gastric adenosquamous carcinomas are stage III or IV advanced cancers, and are treated according to the therapeutic protocol for adenocarcinomas. Their prognosis is generally poor. Continuous follow up is required for patients with these adenosquamous cancers, even after curative resection has been performed, because of the advanced nature of these lesions.

PRIMARY CANCER OF THE SMALL INTESTINE ARISEN IN THE ELEVATED INTESTINE AFTER TOTAL GASTRECTOMY

胃全摘後挙上腸管に発生した原発性小腸癌の1例を経験したので報告する.症例は81歳,男性.平成14年5月10日,胃癌にて胃全摘術が施行された.以後再発症状はなかったが,平成15年5月27日,内視鏡検査にて再建挙上小腸に腫瘤性病変を認め,生検の結果group Vと診断された. CTおよびUSでは他には転移はないと判断し, 6月18日,手術を施行した.腹腔内には転移を疑う所見はなく,年齢を考慮して可及的に挙上腸管を剥離・切離し,再度Roux-Y吻合にて再建した.病理組織学的には中分化腺癌であった.自験例の発癌様式として, (1)胃癌の組織型は低分化腺癌であったこと, (2)初回手術時の腫瘍撒布にしては距離が離れすぎていること, (3)今回の腫瘍の位置が挙上前はTreitz靱帯より50cm以内の空腸であった,すなわち小腸癌の好発部位であることを考慮し,原発性小腸癌と考えた.