食道胃接合部の食道粘膜より発生し胃側へ発育進展した1p型扁平上皮癌の1例

1p Type of Advanced Squamous Cell Carcinoma Located in the Cardia of the Stomach, Developing from the Esophageal Mucosa of the Esophagogastric Junctional Region, Report of a Case

要旨　患者は66歳の男性．特に自覚症状はなく，胃集団検診を受けたところ噴門部の隆起性病変を指摘され当センターを受診．上部消化管内視鏡検査では，噴門部小彎側に厚い白苔を伴った大きさ約4cmの半球状の隆起性病変を認め，水洗すると表面は結節状であったが正常粘膜に近い構造が保たれていた．ヨード染色では隆起は全体的に不染を示していたが，扁平上皮の存在を示唆する濃染粘膜が島状に認められた．またヨード不染帯は，口側の食道粘膜に一部連続しており，食道粘膜との関連が示唆された．隆起表面の生検で扁平上皮癌が検出された．胃精密X線検査では，病変は表面結節状の亜有茎性の半球状隆起で，食道側から1本の太いひだの引き込みがみられた．切除標本の病理組織学的検討から，食道扁平上皮癌が噴門部を中心に1p型に発育進展した病変と診断された．

　A 66-year-old man visited our center for upper gastrointestinal endoscopic examination because of abnormal findings in x-ray examination after a gastric mass survey.

　Endoscopic examination revealed an irregular shaped and hemispherical elevation with fur, approximately 4 cm in size, in the fundic region. Furthermore, endoscopic examination with iodine staining revealed a small unstained area in the esophageal mucosa on the oral side from the unstained tumor. Biopsy specimens of the tumor revealed a squamous cell carcinoma. Upper gastrointestinal x-ray examination revealed a hemispherical elevation with many nodules in the fundic region. Therefore, total gastrectomy combined with lower esophagotomy was performed and histologic examination showed 1p type of advanced squamous cell carcinoma located in the cardia of the stomach, developing from the esophageal mucosa. After x-ray and endoscopic examination with iodine staining, we concluded that careful observation of lesions in esophagogastric junctional region was necessary.