病理組織学的詳細検討にて粘膜下組織へのわずかな癌の浸潤を認めた早期胃癌の高度リンパ節転移症例 [in Japanese] A Case of Early Gastric Cancer with Extensive Lymph Node Metastases in which Tumor Invasion into the Submucosa Was Demonstrated only after Detailed Pathological Examination [in Japanese]
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症例は72歳の女性で，下血の精査で行った上部消化管内視鏡検査で胃体中部大彎に0-IIc病変を認め，生検の結果は低分化腺癌であった．胃癌T1aN0M0 Stage IAの術前診断で，腹腔鏡下幽門側胃切除，D1＋郭清の方針とした．ところが，術中迅速病理組織学的診断でNo.4sbリンパ節転移を認めたため，腹腔鏡下胃全摘，脾合併切除を含むD2郭清を行った．病理組織学的診断は，非充実型低分化腺癌，pT1a，pN3b（19/91）であった．病変を詳細に再評価したところ，粘膜下組織の一部にもごくわずかな癌の浸潤巣を認めた．自験例は，術後に高度リンパ節転移が判明した注意すべき肉眼的粘膜内癌症例であり，当初は病理組織学的にも粘膜内癌と診断されたが，リンパ節転移が高度であるため追加検討を行うこととなり，最終的にはごくわずかな癌の粘膜下層浸潤が確認されたという点で，病理組織学的にも興味深い1例であった．
A 72-year-old woman complaining of melena was admitted to a local hospital. Upper gastrointestinal endoscopy demonstrated a type 0-IIc tumor of the greater curvature in the middle third of the stomach that was determined to be a poorly-differentiated adenocarcinoma. She was referred to our hospital, and laparoscopy-assisted distal gastrectomy with D1+lymph node dissection was performed for the T1aN0M0 Stage IA gastric cancer. Eventually, however, a laparoscopy-assisted total gastrectomy with D2 lymph node dissection including splenectomy was performed because metastases of the left greater curvature lymph nodes along the left gastroepiploic artery were found during intraoperative pathological examination. Histopathological examination demonstrated a non-solid type poorly-differentiated adenocarcinoma confined to the mucosa with metastases to nineteen regional lymph nodes. However, a more detailed pathological examination confirmed a few gastric cancer cells in the submucosa. Meticulous care should be taken when clinically diagnosing intramucosal gastric cancers such as these, in which extensive lymph node metastases are not diagnosed clinically but pathologically. Interestingly, in our case, the tumor invasion into the submucosa was demonstrated only after a more detailed pathological examination.
- The Japanese Journal of Gastroenterological Surgery
The Japanese Journal of Gastroenterological Surgery 45(3), 267-272, 2012
The Japanese Society of Gastroenterological Surgery