This paper presents two cases of carcinoma occurred in the distal gastric remnant. Case 1; A 68-year-old woman, who underwent proximal gastrectomy with esophagogastrectomy and pyloroplasty for a gastric leiomyosarcoma 4 years before, was found to have a Borrmann III type carcinoma at the antrum of the remnant stomach on upper GI series and endoscopy. No distant metastases were detected. Then, total gastrectomy and splenectomy with lymphnode dissection were performed. Histological findings of the resected material were pT₃ pN₃ and poorly differentiated adenocarcinoma.
Case 2; A 76-year-old man, who underwent the same surgery as Case 1 for an early gastric carcinoma in the cardiac region 13 years before, was found to have a superficial depressed lesion at the posterior wall just under the esophagogastrostomy on recent examination. Biopsied specimen disclosed that it was well differentiated adenocarcinoma of the remnant stomach. Operation is suspended at present, because the patient disagreed with surgical treatment.
It is though that the frequency of carcinoma in the distal gastric remnant is probably high after proximal gastrectomy. because the remnant portion is a common site for malignancy and it is exposed with regurgitation of duodenal juice. However, previously reported cases including our two cases numbered only 26 in the Japanese literature for 3 decades since 1968. This paper also presents some bibliographical discussion in terms of clinicopathological pictures and possible carcinogenic mechanisms.