残胃吻合部上のⅡc型胃癌の1例

Type Ⅱc Early Carcinoma at Gastroduodenostomy Site of the Remnant Stomach, Report of a Case

要旨　患者は50歳，女性で19年3か月前に胃ポリープにより胃切除，Billroth Ⅰ法再建術を受けている．腹痛を主訴に当科を受診した．胃X線像には，残胃大彎側の粘膜襞の中断と先細りがあり，これと胃十二指腸吻合線で囲まれた範囲に陥凹病変をみた．内視鏡検査では，胃十二指腸吻合部大彎に発赤した不整なびらんがみられ，その外側領域は退色調を呈していた．退色の内側からの生検で Group V，signet-ring cell carcinoma と診断されたので，残胃全摘術を施行した．摘出標本では大きさ1.7×1.1cmのⅡc型早期癌，組織学的には印環細胞癌で，粘膜下層に浸潤していた．吻合部の胃側粘膜には吻合部ポリープ状肥厚性胃炎の合併はなかった．

　A 50-year-old woman who had undergone gastrectomy (Billroth Ⅰ) for gastric polyp 19 years ago was referred to our hospital because of abdominal pain.

　X-ray examination showed a depressed lesion at the site of gastroduodenostomy in the major curvature of the remnant stomach. A reddish and irregular shaped erosion surrounded by discolored area was found by endoscopic examination. Pathological examination of the biopsy specimen obtained from this lesion showed signet-ring cell carcinoma.

　Total resection of the remnant stomach was performed. An early gastric carcinoma, type Ⅱc (17×11mm in size) with invasion into the submucosa was found in pathological examination of the resected specimen.