内視鏡的粘膜切除後の経過観察中に短期に増大した早期胃癌の1例

Early Gastric Cancer which was Obviously Enlarged during the Half Year Following Endoscopic Mucosal Resection, Report of a Case

要旨　患者は64歳，男性．人間ドックの受診を契機にして体下部大彎に隆起性病変が認められ内視鏡的粘膜切除術（EMR）を行った．病変は術前に生検で腺腫とされたが，切除後には高分化型管状腺癌，深達度mと病理診断された．分割切除のため遺残の判定は困難であった．1.5か月後には切除瘢痕の辺縁に白色の隆起性病変を認め，25か月後，4.5か月後と内視鏡観察するにつれてその病変は増大した．再度手術を勧めたが，拒否されたためEMRを行った．切除5.5か月後のEMR時には初回の病変にほぼ類似する大きさになった．EMRで病変は十分挙上せず遺残したため，レーザー焼灼を追加した．組織像は腺腫であった．その後，3年半経過観察しているが再発は認めない．

　A 64-year-old male was admitted to our hospital for the resection, by endoscopic mucosal resection (EMR), of a gastric lesion in the greater curvature of the lower body. Before EMR the lesion was diagnosed, by biopsy, as an adenoma. After EMR, pathological findings showed that the resected specimen was a well differentiated type of tubular adenocarcinoma as well as being a mucosal cancer. Resectability was not diagnosed because piecemeal resection had been carried out. At 1.5 months after EMR a new discolored elevated lesion was observed endoscopically at the edge of the ulcer scar caused by EMR. Biopsy specimen of the new lesion showed an adenoma. At 2.5 months and 4.5 months after EMR the elevated lesion was seen endoscopically to have gradually enlarged. The patient refused a gastric operation, so the second EMR was carried out 5.5 months after the first EMR. At that time the size of the lesion was almost the same as that of the lesion seen at the time of the first EMR. Complete resection was not obtained by EMR so the lesion was treated by the addition of laser irradiation. In the three and half years since the second treatment there has been no recurrence of the lesion.