典型的な肉眼形態と考えられたA型胃炎に伴う胃カルチノイドの1例

Typical Finding Case of Gastric Carcinoid Tumor with Type A Gastritis, Report of a Case

　症例は49歳，女性．貧血精査目的の上部消化管内視鏡検査で，胃体部大彎に径10mm弱，境界が比較的明瞭で，発赤した過形成性ポリープ様の隆起性病変を認めた．生検にてカルチノイドと診断された．内視鏡で認められた胃体部粘膜の著明な萎縮像，血清ガストリン高値（1,900pg/ml）および抗胃壁細胞抗体陽性所見より，A型胃炎を背景に発生したI型胃カルチノイドと診断した．胃部分切除検体の病理組織検査では，カルチノイド細胞は大部分粘膜内に限局しており，病巣部表面にはびらんと胃小窩の過形成を認めた．既報告例との比較検討により，本症例の内視鏡像および組織像はI型カルチノイドの典型像と考えられた．

　A 49-year-old female underwent upper gastrointestinal endoscopy for diagnostic purpose of anemia. A circumscribed, hyperplastic-polyp-like elevated lesion (about 10 mm in diameter) with redness on the surface was found in the greater curvature of the corpus. The biopsy specimen showed carcinoid tumor. The tumor was diagnosed as type I carcinoid associated with type A gastritis, based on the following findings : endoscopic marked atrophy at the fundic mucosa, elevated serum gastrin level (1,900 pg/ml), and positive test for serum anti-parietal cell antibody. Partial gastrectomy was performed. Histological examination revealed that most carcinoid cells proliferated in the mucosa and the lesion had erosion and foveolar hyperplasia on the surface. Compared with previously reported cases of type I carcinoid, macroscopic and microscopic findings of the present case were considered to be typical of type I carcinoid.