山崎, 将人

ヤマザキ, マサト

胃癌

A 51-year-old-man was admitted to our hospital because of right upper epigastralgia and abdominal fullness. A cystic tumor with calcifcation, 15cm in size located in the right hepatic lobe invading the right kidney. A percutaneous cytology failed in diagnosis. An upper gastrointestinal exmination revealed gastric cancer locating in the lesser curvature. Right hepatic lobectomy, right nephrectomy, cholecystectomy and total gastrectomy were performed on 20th May 1993. Histologically, the gastric cancer was a moderately differenciated adenocarcinoma, 7.5cm in size. The hepatic tumor cells looked like spindle shape like a sarcoma, but typical hepatocellular carcinoma was also seen in the invasive area to the right kidney. There was no transitional form between sarcomatous cells and typical hepatocellular carcinoma. Immunohistochemically, sarcomatous cells were found to be negative to EMA, Keratin, Vimentin and s-100 protein except for Actin. Therefore we diagnosed hepatocellular carcinoma with sarcomatous differentiation. The post operative course was unevetful. The patient died of recurrence of the tumor in the liver, lungs and para-aortic lymph nodes on 7th November, 1993.