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In the present study, we observed that the adenocarcinoma component in the mucosa was continuous with neuroendocrine carcinoma (NEC) in the deeper layers; this suggests the normal course of NEC carcinogenesis at the histological level. A 72-year-old man was admitted to our hospital with a chief complaint of tarry stools. Endoscopic examination of the upper gastrointestinal tract revealed a 2-cm tumor, with a deep central depression, surrounded by a smooth elevated area, in the middle of the stomach body. A biopsy showed that the tumor was a moderately differentiated gastric adenocarcinoma. The patient underwent total gastrectomy and standard lymph node dissection. The resected tumor was a 3.5 × 2.5 cm type 2 lesion. It comprised two elements at the histological level: (i) a moderately differentiated adenocarcinoma in the superficial portion of the mucous membrane layer, and (ii) NEC-like cells with dark, round nuclei and scant cytoplasm, presenting a solid and trabecular pattern, in the submucosal and muscularis propria layers. Immunohistochemical findings showed that the NEC-like cells were diffusely positive for chromogranin A, synaptophysin, neural cell adhesion molecule, and neuron-specific enolase, but were negative for carcinoembryonic antigen. The Ki-67 labeling index was 95%. The final pathological diagnosis was gastric NEC with an adenocarcinoma component and a high cellular proliferative potential.

小児の胆嚢軸捻転症を経験した. 症例は15歳の男児, 右季肋部痛を主訴として当院を救急受診し, 急性腹症の診断で入院となった. 入院時の腹部CTで, 胆嚢の腫大を認め, 保存的治療を行った. しかし, 症状の改善はなく, 9時間後の腹部CTで, 胆嚢の腫大が増強しているにもかかわらず, 胆嚢壁の造影効果を認めなかった. そこで胆嚢軸捻転症を強く疑い, 同日緊急手術を施行した. 腹腔鏡で観察すると, 胆嚢は暗赤色を呈し緊満していた. 胆嚢は完全遊離型胆嚢で, 360°時計方向に捻転していた. 捻転を解除し, 腹腔鏡下に胆嚢摘出術を施行し, 第7病日に退院した. 本邦では, 小児の胆嚢軸捻転症の報告は稀で, 術前診断は比較的困難であるが, 近年, 腹部US, CTなどの画像診断の進歩に伴い術前診断率が向上している. 治療は胆嚢摘出術が原則であり, 最近では腹腔鏡下手術の報告が散見され, 有効かつ良好な経過が期待できる.

転移性卵巣腫瘍より発見された,虫垂原発杯細胞カルチノイドの1例を経験したので報告する.症例は41歳,女性.骨盤内腫瘍の診断で,当院産婦人科で両側卵巣摘出術を施行された.病理組織学的に転移性の粘液産生性腺癌であり,原発巣の検索を行った.その結果,腹部超音波検査およびCT検査で, 5cm程度の長さで虫垂の壁肥厚が認められた.虫垂腫瘍の疑いで外科紹介となり,回盲部切除術を施行した.病理組織学的には,杯細胞を含む上皮細胞が小塊状に配列し,免疫組織化学的には神経内分泌マーカーであるsynaptophysin, chromogranin Aに陽性となる細胞を認めたため,虫垂原発杯細胞カルチノイドと診断した.術後化学療法としてTS-180mg/m2, CPT-1180mg/m2の併用療法を行っているが,再発なく経過良好である.

We experienced a case of early gastric cancer of the anastomosed site occurred about 40 years after a gastrojejunostomy for gastroptosis. A 69-year-old woman was admitted to the hospital because of rectal bleeding of bright red in color. There was a previous history of undergoing gastrojejunostomy for gastroptosis at the age of 29. After admission upper gastrointestinal endoscopy visualized a relatively sharrow depression with slightly rough mucosa surface and two polypoid elevated lesions arround the anastomosed site. The patient was diagnosed as having a type IIc gastric cancer and gallstone. Subtotal gastrectomy (B-I) mainly involving the anastomosed site, partial excision of the jejunum with end-to-end anastomosis, and cholecystectomy were carried out. Histopathologically the cancer lesion was intramucosal cancer (tub2) growing around the oral side of the anastomosis, without infiltration into the jejunum nor lymph node metastasis. There have been 34 cases of gastric cancer following gastrojejunostomy including this case so far. Their average age was 62.3 years. The disease was common in men and often appeared following the operation for peptic ulcer. Their gastric cancers were detected after an average disease-free interval of 27.4 years. Gastric cancers frequently appeared at the anastomosed site and the half of them were in an early stage.