A 42-year-old woman who had a sigmoidectomy for sigmoid colon carcinoma in 1983 and right hemicolectomy for ascending colon carcinoma in 1989 was admitted with a chief complaint of epigastric discomfort in 1995. She was diagnosed by endoscopy as having two advanced gastric carcinomas. Total gastrectomy with splenectomy and Roux-en Y reconstruction was performed on September 28, 1995. Two lesions of type 3 advanced gastric carcinoma on the anterior and posterior walls of the body, and five lesions of type 0-IIa early gastric carcinoma on the antrum and body were observed independently. The two lesions of type 3 advanced gastric carcinoma were histologically diagnosed as moderately differentiated adenocarcinoma invading the subserosal layer. Three of the five lesions of type 0-IIa early gastric carcinoma were diagnosed as well-differentiated adenocarcinoma invading the mucosal layer and the other two were diagnosed as well-differentiated adenocarcinoma invading submucosal layer, respectively. These lesions of gastric carcinoma were stained positively by immunohistochemical staining for p53 and Ki-67, and were negative for c-erbE-2 and bcl-2. Chronic gastritis with intestinal metaplasia was observed, which was positive for Helicobacter pylori infection. It is important that we establish a high risk group by finding out factors, which may predict future occurrence of multiple cancers.
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