内視鏡的粘膜切除術後急速に2型進行癌に進展した噴門部小胃癌の1例

Small Cardiac Cancer Developing into Advanced Cancer within a Short Period after Endoscopic Mucosal Resection, Report of a Case

要旨　患者は86歳，男性．噴門部後壁に認めた小胃癌に対して内視鏡的粘膜切除術を施行したところ，粘膜内にとどまる高異型度の高分化型ないし中分化型管状腺癌と診断されたが，切除断端は熱変性のため不明であった．1か月後の内視鏡検査で局所再発を認め，高周波焼灼術による内視鏡的再治療を行い，いったん生検陰性となったが，再度再発した．高度の呼吸機能低下と高齢を理由に手術は不可能と判断され，やむなく内視鏡的治療を続けたが，再発を繰り返した．その後癌病巣は急速に増大し，初回治療から8か月間で2型進行癌に進展した．再発病変が急速に増大した原因として，内視鏡的治療による刺激が癌細胞の発育を促進した可能性がある．

　A 86-year-old male was admitted to Shinshu University Hospital in September, 1990 for the purpose of endoscopic treatment for small cardiac cancer. He had been suffering from pulmonary tuberculosis and emphysema. A small Ⅱc type gastric cancer on the posterior of the cardiac region was resected using the procedure of endoscopic mucosal resection (EMR) using a 2-channel scope of straight-view type. Histopathologically, well or moderately differentiated adenocarcinoma with high atypia was limited to within the mucosa, but the resected margin could not be evaluated because of heat degeneration by the high-frequent current. Follow-up endoscopy after one month following the EMR revealed local recurrence. It was treated by cauterization with high-frequent current. Local rerecurrence was repeatedly recognized after three and five months. We considered surgical gastrectomy, but the patient was judged to be unable to tolerate such an operation because of respiratory dysfunction and high age. Reluctantly we repeated endoscopic re-treatment, but the residual cancer rapidly enlarged and developed into a 2 type advanced cancer eight months after the first endoscopic treatment.