Ⅱc＋Ⅱa主病巣近傍の多発微小病変からのEMR後遺残再発の1例

Local Recurrence after Mucosectomy Derived from Isolated Minute Carcinoma Adjacent to Type Ⅱc+Ⅱa Early Gastric Cancer, Report of a Case

要旨　患者は59歳，男性．心窩部不快感，嘔気のため胃内視鏡検査を受け，胃角部大彎にⅡc病変を指摘された．分化型Ⅱc，深達度mと診断しstrip biopsyを施行，32×29mmの粘膜が切除された．19×9mmのⅡc＋Ⅱa型癌，tub1，m，ly₀，v₀，切除断端陰性であり，一括完全切除と判定した．切除後3年5か月目に再発し，マイクロ波凝固治療を施行した．再治療後1年9か月まで局所治癒している．切除標本の見直しでは，主病変と離れて存在する微小癌により切除断端陽性となっていた．不完全切除例の5年非再発率は，追加治療なしでは57％，凝固治療追加例で96％であった．遺残再発の原因としてはまれな症例を報告し，合わせて，遺残再発時，および追加治療としての，マイクロ波凝固の有用性について述べた．

　A 59-year-old man, complaining of epigastric discomfort and nausea, underwent an endoscopic examination at our hospital. He was found to have type Ⅱc early gastric cancer which was treated thereafter with endoscopic mucosectomy. Type Ⅱc+Ⅱa mucosal carcinoma measuring 19×9 mm was found within the resected gastric mucosa measuring 32×29 mm. Complete removal of the tumor was confirmed by stereo-microscopic and histologic findings, revealing well differentiated tubular adenocarcinoma (tubl), m, ly₀, v₀, cut-end negative. Endoscopic examination with biopsy disclosed a local recurrence at three years and five months after mucosectomy. The lesion was treated by microwave coagulation therapy, and has been locally controlled for one year and nine months. Re-evaluation of the resected specimen disclosed a minute carcinomatous focus on the cut margin, that was found to be separated from the main tumor. In cases of incomplete resection, the five-year accumulative non-recurrence rate after mucosectomy was 57%, but was 96% when coagulation therapy was added. A case of local recurrence after mucosectomy arising from a rare cause was presented, and usefulness of microwave coagulation as a supplementary therapy for incomplete mucosectomy and for local recurrence was discussed.