術前に診断しえた細小肝癌と早期胃癌の同時性重複の１女性例

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  • A case of synchronous double cancers small liver cancer and early gastric cancer.

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A 70-year-old woman, who was found to have liver dysfunction and an elevated AFP level, was referred to our hospital. Laboratory data showed elevated serum transaminase activities and impaired ICG excretion. The serum AFP level was elevated to 333 ng/ml and CEA level was 4.0 ng/ml. She also showed positive stool occult blood (Table 1). Laparoscopy revealed a small hemispherical tumor protruded on the right lobe of the liver. A diagnosis of hepatocellular carcinoma was confirmed by guided needle biopsy (Figure 1). Ultrasonography, CT and angiography, however, failed to detect this tumor because of its small size and subdiaphragmatic localization. On the other hand, upper GI series and endoscopy revealed a IIc+IIa type early gastric cancer on the posterior wall of the antrum (Figure 4, 5). Right partial lobectomy of the liver and curative operation for the gastric cancer were performed. The resected specimen of the liver showed a small encapsulated tumor measuring 18×18 mm in diameter. Histology showed Edmondson III hepatocellular carcinoma with hepatic cirrhosis. Gastric lesion revealed a IIa+IIc type early gastric cancer and disclosed moderately differenciated adenocarcinoma of medullary type involving the mucosal layer without lymph node metastasis (Figure 6). AFP level returned to normal and no recurrence was observed 11 months after operation. This is a rare case of small hepatocellular carcinoma simultaneously associated with early gastric cancer, occurring in a female patient diagnosed preoperatively by laparoscopy, although other diagnostic methods failed to elucidate its location.

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