胃壁内の異所性胃腺より発生した胃癌の1例

Gastric Cancer Derived from Heterotopic Gastric Glands, Report of a Case

要旨　患者は70歳，女性．主訴は食後の心窩部不快感．上部消化管造影検査および内視鏡検査にて胃体上部大彎に中心に陥凹を伴う粘膜下腫瘍様病変が認められ，3回目の生検にて中分化型腺癌と診断された．胃全摘術を施行した．切除標本では隆起病変の大きさは20×15mmで，中心の陥凹部は8×8mmであった．病理組織学的所見はtub2，sm，ly1，v1，n0で，癌の進行度はT1，N0，P0，H0，M0，stage IAであった．癌病変はすべて粘膜下層に存在し，癌病変周囲には胃底腺を含む正常な胃粘膜が併在し，粘膜筋板は認められなかった．以上より粘膜下層の異所性胃腺より発生した胃癌と考えられた．

　We present a case of gastric cancer resembling submucosal tumor. The patient was a 70-year-old female with epigastric discomfort after meals as her chief complaint. Upper gastrointestinal series and endoscopy revealed a submucosal tumor-like lesion with central ulceration in the upper portion of the stomach. Three biopsies were made and the third one revealed moderately differentiated adenocarcinoma. Total gastrectomy was performed. The resected specimen showed an elevated lesion measuring 20×15 mm with a slight depression in the center measuring 8×8 mm. Histologically, the tumor was diagnosed as moderately differentiated adenocarcinoma (sm, ly1, v1, n0). Clinical staging was rated as Stage IA (T1, N0, P0, H0, M0). The tumor was limited within the submucosal layer and was composed of cancer and heterotopic gastric glands without muscularis mucosae. It was considered as an early gastric cancer derived from heterotopic gastric mucosa which had developed in the submucosal layer.