遡及的に5年間の形態変化が確認できた異所性胃粘膜腺管より発生した胃癌の1例

Gastric Cancer Arising from Ectopic Gastric Mucosa Glands, Report of a Case

要旨　症例は，66歳，男性．再発性十二指腸潰瘍のため，1983年より当科へ不定期に通院していた．1997年5月の上部消化管内視鏡検査の際，十二指腸潰瘍の再発と胃体下部大彎後壁に，ひだの融合と中断を伴った粘膜下腫瘍様病変を認めた．2年後(1999年)，中央部に不整な陥凹を有する粘膜下腫瘍様のIIa＋IIcへと形態が変化したため，診断確定のために内視鏡的粘膜切除術を施行した．病理学的検索では粘膜下異所性胃粘膜腺管の癌化と診断された．癌は粘膜面には露出しておらず，陥凹境界部に生じた不整所見の原因は不明であった．異所性胃粘膜腺管の癌化は極めてまれである．遡及的ではあるが5年間の内視鏡所見の変化も併せて報告した．

　A 66-year-old man had been followed up because of a recurrent duodenal ulcer, since 1983. In May, 1994 we detected, by upper gastrointestinal endoscopic examination, an elevated lesion resembling a submucosal tumor accompanied by fusion of the folds nearby in the greater curvature of the lower gastric body. In 1997, these findings were almost the same as those of the previous examination. In 1999, the findings revealed a IIa＋IIc-like lesion with an irregular groove on its top. However, the biopsy specimens could not detect any malignancy. Endoscopic mucosal resection was performed in order to enable a diagnosis. Eventually a submucosal gastric cancer arising from ectopic gastric mucosa glands was diagnosed.