胃癌と腹膜炎を契機に発見された虫垂癌の重複癌の1例 A CASE OF DOUBLE CANCER OF AN APPENDICEAL CANCER WITH APPENDICITIS AND A GASTRIC CANCER
胃癌と腹膜炎を契機に発見された虫垂癌の重複癌の1例を経験したので報告する.<br> 症例は74歳,男性.平成7年5月他院で貧血の精査を行い胃癌と診断され,外来で術前検査中であった. 7月3日持続する激しい腹痛が出現し当科受診.腹部所見で筋性防御を認め汎発性腹膜炎と診断,同日緊急手術を施行した.腹腔鏡で腹腔内を観察し,虫垂炎穿孔による汎発性腹膜炎と診断,右傍腹直筋切開で虫垂切除・腹腔ドレナージ術を施行した.全身状態の改善後上部消化管の精査を行い,胃C領域の1'-T<sub>3</sub>型胃癌と診断した. 8月1日,胃全摘術・脾合併切除術, D1郭清を施行し,根治度Cであった.病理所見では,虫垂は原発性の中分化腺癌,胃癌も原発性の中分化型腺癌であった.さらに免疫組織染色を施行したところ,抗CEA免疫組織染色では両癌とも陽性であったが,抗CA19-9免疫染色は胃癌のみ陽性を示し,同時性重複癌と診断した.
A case of double cancer involving the appendix and stomach is reported, in which the appendiceal cancer was detected during treatment of the gastric cancer with peritonitis.<br> A 74-year-old man with gastric cancer who was receiving preoperative examinations for the gastric cancer at another hospital developed a lasting severe abdominal pain, and was admitted to the hospital. On physical examinations, there was muscular defence and a diagnosis of panperitonitis was made. An emergency operation was performed on the day of admission. After laparoscopic study that revealed much pustulant ascites for perforated appendicitis in the abdominal cavity, appendectomy and abdominal doranage were performed.<br> With upper gastrointestinal series performed after his general condition was improved, he was diagnosed as having an advanced gastric cancer (1'-T3 type) at the C area. A total gastrectomy and splenectomy with lymph node dissection were performed, resulting in curability C.<br> Histological examinations revealed a primary moderately differentiated adenocarcinoma of the appendix and primary moderately differentiated adenocarcinoma of the stomach. Both cancers gave positive reactions to and CEA immunological staining, but only gastric cancer showed a positive reactions anti CA19-9 staining. Both cancers were diagnosed as synchronous double cancer.
- 日本臨床外科学会雑誌 = The journal of the Japan Surgical Association
日本臨床外科学会雑誌 = The journal of the Japan Surgical Association 59(4), 1158-1162, 1998-04-25