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特異な発育形態により診断に難渋したAFP産生胃癌の1例

■巻ページ:高知市医師会医学雑誌第17巻第1号  194~201頁 2012年
■表題:特異な発育形態により診断に難渋したAFP産生胃癌の1例
■著者:上月章史
■共著者:志摩泰生、村岡玄哉、河北直也、大石一行、住吉辰朗、齋坂雄一、寺石文則、尾崎和秀、澁谷祐一、岩田純

■要旨(はじめに)
症例は62歳,男性。前医のCTで肝腫瘤を指摘され当院へ紹介となった。CTで肝両葉に多発腫瘤と,胃所属リンパ節の腫大を認め,各種腫瘍マーカー(AFP,CEA,CA19-9)の上昇を認めた。PET-CT検査で肝S6/5およびS1の腫瘤と胃幽門輪近傍にFDGの異常集積を認めた。内視鏡検査では胃角部から前庭部に多発潰瘍を認めたが,悪性を疑う所見はなく,潰瘍からの生検結果はGroup1であった。肝内胆管癌,混合型肝癌,胃癌肝転移などを疑ったが確定診断に至らず,診断目的に開腹手術を施行した。手術では胃前庭部に腫瘍を認め,胃癌原発の転移性肝癌と診断して胃前庭部切除,肝腫瘍針生検を施行し,病理検査でAFP産生胃癌と診断した。胃の切除標本の肉眼的所見は,潰瘍底が十二指腸側に向いた 2型病変が幽門輪に一致して存在し,口側からの内視鏡観察では接線方向となり正常粘膜しか確認できない特異的な発育を示していた。

■Key words:ポリマーフューム熱,急性肺水腫,フッ素樹脂加工鍋
■備考:こうづき あきひと 〒781-8555 高知市池2125-1 高知医療センター 消化器外科

■title:A case of AFP-producing gastric cancer showing a peculiar growth pattern making a definitive diagnosis difficult
■the author:Akihito Kozuki
■Abstract:The case was a 62-year old male who was referred to our hospital
from his previous doctor, who detected hepatic mass in CT. Multiple masses in
bilateral hepatic lobes and enlargement of the gastric regional lymph nodes
were found in a CT, and levels of various tumor markers (AFP, CEA, CA19-9)
were elevated. PET-CT tests showed S6/5 and S1 hepatic masses and abnormal
accumulation of FDG near the pyroric ring of stomach. Endoscopic test showed
multiple ulcers from the angular region to the antrum of the stomach but
showed no findings suggestive of malignancy. The results of biopsy from the
ulcers was Group 1. Although there was suspicion of intrahepatic cholangiocarcinoma,
combined hepatocellular and cholangiocellular carcinoma,
hepatic metastasis of gastric cancer, and other causes, a definite diagnosis was
not established and therefore laparotomy was conducted for the purpose of
diagnosis. During the surgery, a tumor was observed in the gastric antrum and
diagnosed as metastatic liver cancer of gastric cancer. Gastric antrectomy and
needle biopsy of the liver tumor were conducted. In a pathological examination,
the tumor was diagnosed as AFP producing gastric cancer. This case indicated
a peculiar growth pattern in which macroscopic findings of a gastrectomy
specimen showing a Type 2 lesion with ulcer floor facing duodenum was aligned
with a pyroric ring, and endoscopic observation via the mouth showed only
normal mucosa because the ulcer floor was located in a tangential direction.
■Key words:polymer fume fever, acute pulmonary edema, fluoro-resin-coated pan