Nakano H, Nakahara Y, Mizumoto K, Yoshioka Y, Tamura Y, Tanabe M, Ogino T
Department of Surgery, Yamaguchi Rosai Hospital, Onoda, Japan.
Nihon Geka Gakkai Zasshi. 1987 Aug;88(8):1024-30.
A 72 year-old man visited our hospital complaining of anorexia and hungry epigastric pain. Gastroscopy and upper G-I series examination established the diagnosis of double gastric cancers. Total gastrectomy, R2 lymphadenectomy and beta anastomosis were performed. The type IIc early cancer lesion at the pyloric vestibule was sm in depth and revealed a histological pattern of tubular adenocarcinoma. The multiple lesions on the anterior and posterior walls of the lesser curvature were a cluster of submucosal cysts, and were partially accompanied by signet-ring cell carcinoma having the depth m. The two lesions were histologically isolated without continuity, and the histology progress was PoHoeta (-) ps(-), Stage I, aw(-), ow(-). Postoperative course was uneventful. Though multiple diffuse ectopic gastric mucosa is seemed to be benign submucosal tumor of the stomach, occasional co-existence of cancer has been frequently reported. Even if the results of gastroscopy and upper G-I series results are negative, there is always a possible risk of overlooking a small cancerous focus. On detecting ectopic gastric mucosa, immediate and thorough resection seems desirable, especially when accompanied by cancer. The pathogenesis of multiple diffuse ectopic gastric mucosa has remained controversial and has been explained by the theory of either congenital or acquired aberration. From the histological findings, the pathogenesis of this case could not be determined.
一名72岁男性因厌食和上腹部饥饿痛前来我院就诊。胃镜检查和上消化道造影检查确诊为双胃癌。行全胃切除术、R2淋巴结清扫术和β吻合术。幽门前庭处的IIc型早期癌病变深度为sm，组织学类型为管状腺癌。胃小弯前后壁的多个病变为一群黏膜下囊肿，部分伴有深度为m的印戒细胞癌。这两个病变在组织学上相互孤立，无连续性，组织学进展为PoHoeta (-) ps(-)，I期，aw(-)，ow(-)。术后过程顺利。虽然多处弥漫性异位胃黏膜看似是胃的良性黏膜下肿瘤，但偶尔合并癌症的情况也屡有报道。即使胃镜检查和上消化道造影结果为阴性，也始终存在漏诊小癌灶的风险。在发现异位胃黏膜时，尤其是伴有癌症时，立即进行彻底切除似乎是可取的。多处弥漫性异位胃黏膜的发病机制仍存在争议，有先天性或后天性畸变理论两种解释。从组织学结果来看，该病例的发病机制无法确定。
