Billroth Ⅱ法残胃吻合部小彎のⅡc型早期癌の1例

Type Ⅱc Early Carcinoma at the Lesser Curvature of a Gastrojejunostomy Site of Billroth Ⅱ Reconstruction

要旨　患者は64歳，男性．35年前に胃潰瘍のために胃切除術を受け，結腸後のBillroth Ⅱ法によって再建されている．下血を主訴に当院を受診した．出血の原因はMalloryWeiss症候群によるものであったが，残胃吻合部小彎にⅡc型早期癌を見出した．X線像ではひだ集中が，内視鏡的には褪色調が目立つ病変であった．残胃吻合部切除を行った摘出標本では，大きさは2.0×1.2cm，組織学型はtub2で，深達度はmであった．このほかに0.1cmの微小癌を有していた．肉眼的には明らかでなかったが，吻合部の胃側粘膜には全長にわたって，胃小窩の延長，偽幽門腺の増殖と囊胞化，固有腺の萎縮，腺の粘膜下侵入といった吻合部ポリープ状肥厚性胃炎の組織像が確認された．

　A 64-year-old male had been gastorectomized and reconstructed using the Billroth Ⅱ method for a gastric ulcer 35 years previously. He was admitted to our hospital with the complaint of tarry stool. Mallory-Weiss syndrome was the cause of gastrointestinal tract bleeding and the Ⅱc lesion was detected at the lesser curvature of the gastrojejunostomy site. A depressed lesion with fold convergence was revealed by x-ray examination and through discoloration by endoscopy. Partial resection of the remnant stomach was performed. Detailed histologic examination of the lesion, which measured 2.0×1.2 cm, confirmed moderately differentiation tubular adenocarcinoma and revealed that the tumor was located in the mucosa accompanied by another minute carcinoma. The gastrojejunostomy site beare the microscopic features of gastritis cystica polyposa (stomal polypoid hypertrophic gastritis), with foveolar hyperplasia and cystic dilatation of the pseudopyloric glands and their submucosal invasion but this was not visible macroscopically.