広範な平坦型胃villous tumorの1例

Villous tumor of the Stomach, Report of a Case

要旨　患者は75歳，男性．検診目的の胃X線検査で広範な扁平隆起性病変を認めた．X線上，隆起表面はいわゆる“soap-bubble”appearanceを呈し，胃壁の伸展性は保たれていた．内視鏡では，表面顆粒状ないし結節状の平盤状隆起が体上部から前庭部まで全周性に拡がっていた．生検診断はGroupⅢであったが，病変の形態から悪性を否定できず，胃全摘術を施行した．切除標本では19×11×0.7cmの平盤状隆起で，その表面は肉眼的に絨毛状の外観を呈していた．病理組織学的には，腺管絨毛腺腫を主体として一部に高分化腺癌を含んでおり，villous tumorと診断した．

　A 75-year-old man was admitted to our hospital for a gastric tumor. He had no symptom and physical examination was unremarkable. Laboratory findings were normal except for positive fecal occult blood. An upper gastrointestinal series demonstrated a large intragastric tumor involving the gastric body extending into the antrum, which showed a“soap-bubble”appearance. Endscopic findings showed a large sessile, flatly elevated tumor which occupied the entire circumference of the lumen. Although multiple biopsies revealed tubulovilkrus adenoma, total gastrectomy was performed because of the possibility of focal cancer.

　Grossly, the tumor measuring 19×11×0.7 cm was a broad-based, flatly protruded lesion with villous and fine granular surface. Microscopically, the lesion consisted of a proliferation of adenomatous epithelium growing in a striking villous pattern, partly composed of well differentiated adenocarcinoma.