画像所見と組織所見を対比したEB-virus関連胃粘膜内癌の1例

Epstein-Barr Virus-associated Gastric Mucosal Carcinoma, Report of a Case

要旨　患者は50歳代，女性．胃X線・内視鏡像では，胃角部前壁に15mm大の境界不明瞭な不整粘膜領域が認められ，浅い陥凹と顆粒状粘膜で構成されていた．NBI拡大内視鏡像では，陥凹部に腺管模様の不明瞭化と不規則な走行を示す異常血管模様が認められた．一方，顆粒状粘膜部には小型で類円形の腺管模様と線状の血管模様を認め，陥凹部と組織構築が異なることが推測された．ESD後の組織所見との対比の結果，陥凹部は低分化型主体，顆粒状粘膜部は中分化型主体の粘膜内癌であった．免疫染色による粘液形質は無形質で，腫瘍部に一致してEBER-ISH陽性でEB-virus関連胃癌と最終診断された．

　A 50-year-old woman. In the radiographic and endoscopic findings, an irregular area with an indistinct boundary was admitted. The irregular area was composed of a shallow depression and fine granular parts.

　In the magnifying endoscopic findings, unclear glandular pattern and abnormal surface microvascular pattern in the depressed parts admitted. On the other hand, surface glandular pattern with round shape and linear microvascular pattern were observed as fine granular parts.

　The histological construction of both was presumed to be different.

　Histological depressed parts were poorly differentiated adenocarcinoma. On the other hand, fine granular parts were moderately differentiated tubular adenocarcinoma.

　Final diagnosis was Epstein-Barr virus-associated gastric mucosal carcinoma.