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要旨 生検組織診断で組織異型が弱いことで,2年7か月経過観察を行った胃型分化型sm胃癌の1例を経験した.患者は78歳,男性.自覚症状は特になく,1997年3月,検診目的で東京都がん検診センターを受診.胃内視鏡検査で,胃体中部後壁に発赤調の扁平隆起が認められた.同時に行った生検ではGroup Vと診断されたが,異型度が弱く再検査が指示された.その後の検査で,明らかなGroup Vと診断されなかったため,十分なインフォームド・コンセントのうえで,厳重な経過観察を行った.1998年5月(1年2か月後)の臨床所見で病変の増大傾向がみられたが生検組織診断はGroup IIIであった.1999年7月(2年4か月後)には病変はさらに増大傾向を認めたが,生検診断はGroup IIであった.しかし,これまでの臨床経過から悪性と判断し,1999年10月に手術が予定され,その術前検査として施行した内視鏡生検でGroup Vの所見が得られた.病理組織診断は肉眼型Type 0 I,大きさ50×45mm,組織型tubular adenocarcinoma, well differentiated type(tub1),深達度sm1,ly0,v0であり,粘液組織学的には45M1(2+),M-GGMC-1(+),MUC-2(-)であったことから胃型の粘液形質を有する分化型腺癌と診断された.胃型分化型癌のX線・内視鏡所見の特徴,発育進展様式,生検組織所見の問題など示唆に富む症例である.
A 78-year-old man underwent endoscopic examination for a medical check-up. The endoscopic study showed a slightly reddish, flat elevated lesion at the posterior wall of the middle part of the gastric body.
The tumor which was discovered by radiologic examination was 40 mm in diameter. Although the biopsy specimen was diagnosed as Group V, it showed relatively low grade atypia, so the patient was followed up closely after making informed consent.
During the follow-up period of 2 years 7 months, endoscopic biopsies were performed 8 times, and were diagnosed as Group II-IV.
After 2 years 7 months, the lesion had grown to 50 mm in size. The biopsy specimen obtained at the time of the 9th endoscopic examination led to the diagnosis of Group V. The patient then underwent surgical resection.
Pathologic diagnosis was, macroscopically, Type 0 I,50×45 mm in size, and, microscopically, tubular adenocarcinoma, well differentiated type (tub1), sm1, ly0, v0, and 45M1(2+), M-GGMC-1(+), MUC-2(-) by mucin histochemistry.
This case was highly informative concerning various aspects of the radiologic, endoscopic, and histopathologic diagnosis, and also concerning the distinctive growth pattern of the gastric type of well differentiated adenocarcinoma.
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