除菌後の非萎縮粘膜を背景に地図状発赤に類似した胃底腺粘膜型腺癌の1例

Gastric Adenocarcinoma of the Fundic Gland-mucosa Type Resembling Map-like Redness, Report of a Case

要旨●患者は70歳代，女性．H. pylori除菌後（10年前）の内視鏡検査で胃体下部小彎前壁寄りに，非萎縮性粘膜を背景とする発赤調の陥凹性病変を認めた．病変の前壁側には上皮下腫瘍様の隆起を示していた．陥凹部のNBI併用拡大観察では大小不同を伴い窩間部が開大した不整な表面微細構造を有していた．生検で胃底腺型腺癌の診断となりESDを施行した．病理診断は粘膜下層浸潤（T1b1）を来した胃底腺粘膜型腺癌の所見であった．

　Gastroscopy of a woman in 70s-year-old revealed a reddish depressed lesion, approximately 10mm in diameter on a nonatrophic mucosa in the lesser curvature of the lower gastric body. The lesion resembled map-like red mucosa that are observed following Helicobacter pylori eradication. On the side closer to the anterior wall, the lesion exhibited a subepithelial tumor-like elevation. Magnifying endoscopy with narrow-band imaging revealed a demarcation line with an irregular microsurface pattern. Furthermore, biopsy revealed gastric adenocarcinoma of the fundic gland type ; subsequently, endoscopic submucosal dissection was performed. The final diagnosis was gastric adenocarcinoma of the fundic gland-mucosa type with submucosal invasion.