大網充填術施行部から発生したと思われる進行胃癌の1例

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Introduction : We report a case of patient with advanced gastric cancer that might develop in the region where omental implantation was previously performed.
Case : A 73-year-old man had undergone laparotomy for a gastric ulcer when he was in his 20s. Based on detailed examinations for anemia, a type 2 lesion was observed close to the anterior wall of the greater curvature in the gastric body. We performed a distal gastrectomy, D2 lymph node dissection, and Billroth I. There was no ulcer scar in the resected specimen except the main lesion ; the greater omentum was sucked down into the main lesion. Pathological specimens showed that the greater omentum directly adhered to cancer in the center of cancer without a serous membrane between the greater omentum and cancer.
Discussion : We concluded that the previous laparotomy would be omental implantation for gastric perforation. In this case, the main lesion of gastric cancer was considered to be advanced gastric cancer that arose from the remained gastric mucosa in the region of the perforated ulcer where the greater omentum had been implanted. Based on the morphological analysis, our case was notable because advanced gastric cancer developed in the region where omental implantation was previously performed.