胃型の分化型胃癌の1例

Differentiated Adenocarcinoma Which Was an Expressed Gastric Phenotype in the Stomach, Report of a Case

要旨　患者は60歳の女性．検診で胃ポリープを指摘され精査目的に受診した．上部消化管内視鏡検査では，胃体上部後壁に約15mmの山田Ⅲ型の隆起性病変を認めた．境界は比較的明瞭で，表面は小顆粒状粘膜を呈していた．生検による良悪性の判別が困難であり，内視鏡的粘膜切除術を施行した．病理組織学的所見は高分化型腺癌，粘膜内癌と診断された．粘液染色では，HID-AB染色，ConA染色陰性でありGOS染色に陽性を示した．以上から，胃型の粘液形質を有する分化型腺癌と診断した．まれに認められる胃型の分化型腺癌であり，その臨床病理学的特徴について，文献的考察を加えて報告する．

　In a 60-year-old female a gastric polyp was detected during a medical check up and she was referred to our hospital. Endoscopic examination revealed a polypoid lesion (Yamada Ⅲ shaped) 15 mm in diameter, located on the upper body near the posterior wall of the stomach. The boundarise of this polypoid lesion were relatively clear and the surface showed small granular change. Histological examination of the biopsy specimen was unable to distinguish whether the lesion was benign or malignant. Endoscopic mucosal resection was carried out and, histologically, this lesion was a well differentiated tublar adenocarcinoma within the mucosal layer. GOS staining was positive for the tumor. As a result, we concluded this lesion was a differentiated adenocarcinoma which was an expressed gastric phenotype in the stomach.