家族性大腸腺腫症に伴う胃底腺ポリポーシスの腫瘍化により生じた進行胃癌の1例

Advanced Gastric Cancer Resulting from Tumorigenesis Associated with Fundic Gland Polyps in Familial Adenomatous Polyposis (FAP) Patient, Report of a Case

要旨　患者は39歳，女性．20歳代半ばに家族性大腸腺腫症（FAP）に対して全結腸切除術を施行されている．その後胃底腺ポリポーシスを経過観察していたが，今回上部消化管内視鏡検査において胃体上部大彎に潰瘍性病変を指摘され，精査加療目的に入院となった．上部消化管内視鏡検査では胃穹窿部から体部にびまん性の胃底腺ポリポーシスを認め，胃体上部大彎には境界明瞭な発赤調の潰瘍性病変およびその病変を取り囲むようにポリープの癒合および平坦化を伴う周囲よりやや褪色調の局面を認めた．以上よりFAPに伴う胃底腺ポリポーシスに発生した進行胃癌と診断し局所切除術を施行した．FAPに伴う胃底腺ポリープに関しては，ポリープの癒合傾向，平坦化，色調の変化（褪色化）といった変化に注目して腫瘍化の有無について観察する必要がある．

　The patient was a 39-year-old woman. She had an operation (total colectomy) for FAP at 26 years of age. Upper endoscopic examination had been performed once a year since 2001. She was admitted to our hospital because upper endoscopy revealed a small ulcerative lesion and further examination was required. Gastric radiography and upper endoscopy revealed numerous small polyps spreading over the stomach except in the antrum. A small, reddish ulcerative lesion with surrounding elevation was observed in the greater curvature of the upper gastric body. Around the lesion, fusion and flattening of the polyps was also demonstrated. A biopsy specimen revealed a well-differentiated adenocarcinoma. CT examination detected liver metastasis. Partial gastrectomy and partial hepatectomy was performed. This case of advanced gastric cancer resulted from tumorigenesis associated with fundic gland polyps in an FAP patient. We proposed that in FAP patients, it is important to observe carefully fusion or flattening of fundic gland polyps.