Miyauchi Tatsuomi, Miyaki Akira, Ida Arika, Kishibe Saki, Yamaguchi Kentaro, Shiozawa Shunichi, Usui Takebumi, Kuhara Kotaro, Kono Teppei, Naritaka Yoshihiko
Dept. of Surgery, Nagareyama Central Hospital.
Gan To Kagaku Ryoho. 2016 Nov;43(12):1890-1892.
An 82-year-old woman presented to our hospital with a complaint of frequent vomiting. She was admitted for intensive examination and treatment. Abdominal computed tomography revealed that her stomach was severely expanded, and the wall of the ascending colon was thickened throughout its circumference. Upper gastrointestinal endoscopy uncovered severe stenosis in the pylorus and an elevated lesion resembling a submucosal tumor on the posterior wall of the pylorus. Biopsies of the lesion revealed that it was of Group 1. On colonoscopy, type 2 cancer was found in the ascending colon throughout the circumference, and the biopsies revealed that it was of Group 5. Upper gastrointestinal endoscopy was repeated, and the same result was obtained. The possibility of malignancy could not be excluded; therefore, distal gastrectomy and right colectomy were performed. In terms of histopathology, both resected specimens displayed poorly differentiated adenocarcinoma; however, immunohistochemical studies revealed differences in staining at the two sites. The case was diagnosed as synchronous double cancer involving gastric cancer resembling a submucosal tumor with stenosis in the pylorus and ascending colon cancer. Gastric cancer resembling a submucosal tumor is usually difficult to diagnose on biopsy. If the endoscopic findings reveal an elevated lesion resembling a submucosal tumor with stenosis, then the possibility of carcinoma should be considered, and the most suitable treatment should be selected.
一名82岁女性因频繁呕吐前来我院就诊。她入院接受了详细检查和治疗。腹部计算机断层扫描显示其胃部严重扩张，升结肠壁全周增厚。上消化道内镜检查发现幽门严重狭窄，幽门后壁有一个类似黏膜下肿瘤的隆起病变。病变活检显示为1型。结肠镜检查发现升结肠全周为2型癌，活检显示为5型。再次进行上消化道内镜检查，结果相同。不能排除恶性肿瘤的可能性，因此进行了远端胃切除术和右半结肠切除术。在组织病理学方面，两个切除标本均显示低分化腺癌；然而，免疫组化研究显示两个部位的染色存在差异。该病例被诊断为同时性双癌，包括幽门狭窄伴类似黏膜下肿瘤的胃癌和升结肠癌。类似黏膜下肿瘤的胃癌通常在活检时难以诊断。如果内镜检查发现类似黏膜下肿瘤的隆起病变并伴有狭窄，则应考虑癌变的可能性，并选择最合适的治疗方法。
