胃内に無数の胃底腺型胃癌（胃底腺型腺癌，胃底腺粘膜型腺癌）を有する1例

Numerous Lesions of Gastric Adenocarcinoma of Fundic-gland and Fundic Gland-mucosa Type in a Patient

要旨●患者は60歳代，男性．当科で施行したEGDで，胃体上部に30mmの隆起性病変を認めた（主病変）．また，胃穹窿部〜胃体部にかけて，褪色調の平坦な粘膜病変と発赤調の上皮下腫瘤様の小隆起が多発していた（同時性多発病変）．これらの多発病変から生検を施行した結果，組織学的には，胃底腺型腺癌もしくは胃底腺粘膜型腺癌であった．診断的治療目的に主病変のESDを施行したところ，組織学的には胃底腺粘膜型腺癌であった．また，主病変の周囲には胃底腺粘膜型腺癌（2病変）と胃底腺型腺癌（30病変以上）が認められた．胃内に無数の胃底腺型胃癌（胃底腺型腺癌，胃底腺粘膜型腺癌）が多発していることから，胃全摘術も考慮されたが，患者が外科治療を希望しなかったため，6か月ごとの内視鏡検査とCTでの経過観察の方針とした．治療後約8年が経過しているが，個々の病変に明らかな増大は認められず，また，全身CTスキャンで他臓器転移の所見は認められなかった．以上のような胃内に無数の胃底腺型胃癌を有する症例の報告はなく，報告した．

　Upper gastrointestinal endoscopy performed at our hospital on a man in his 60s revealed a 30-mm elevated lesion in the upper stomach（main lesion）. There were several discolored, flat mucosal lesions and slightly elevated, reddish, subepithelial mass-like lesions（multiple secondary lesions）in the gastric fornix and body. Histopathological examinations of several biopsied secondary lesions revealed gastric adenocarcinoma of fundic-gland type（GA-FG）or gastric adenocarcinoma of the fundic gland-mucosa type（GA-FGM）. The main lesion was suspected to be GA-FGM on magnifying endoscopy with narrow-band imaging. It was resected via endoscopic submucosal dissection for therapeutic and diagnostic purposes. The histopathological diagnosis of the resected lesion was GA-FGM, which was surrounded by two GA-FGM and >30 GA-FG lesions. Although total gastrectomy was considered, the patient declined further surgical treatment. Therefore, he was followed up with biannual endoscopy and computed tomography. Five years postoperatively, there has been no observed tumor growth or metastasis. To the best of our knowledge, this is the first case of the simultaneous presentation of numerous GA-FG and GA-FGM lesions in the stomach.