経過観察からみたA型胃炎に伴う胃カルチノイドの動態

Endoscopic Surveillance of Gastric Carcinoid Tumors Associated with Gastritis Type A

要旨　A型胃炎に伴う胃カルチノイドの2切除例を検討し，本腫瘍の増殖能は弱く，胃全摘術などの過剰な手術は必要ないと考え，その後の症例に無治療で経過追跡を試みた．5例に対して6か月おきの内視鏡検査，1年おきの血中ガストリン値測定と腹部CT検査を行った．最長6年10か月間経過した1例のカルチノイド腫瘍は肉眼的に消退した．残りの4例では大きさの変化は認められなかったが，1例で頂部のびらんの出現が経過中に観察された．血中ガストリン値の変動も少なく，腹部CT検査で肝転移やリンパ節転移が出現した症例も存在しなかった．A型胃炎に伴う胃カルチノイドには直ちに治療を行う必要のない腫瘍が含まれると考えられた．

　Examining two resected cases of gastric carcinoid tumors associated with gastritis type A, we considered that these tumors were harmless and that there was no indication for major surgery such as total gastrectomy. Five patients who had been diagnosed as having such tumors were followed up with gastroscopy at 6-month intervals along with examination of serum gastrin and abdominal CT at one-year intervals. Endoscopically, the carcinoid tumors were shown to have regressed in one patient who had been followed up for 6 years and 10 months. The tumors of the remaining four patients have not changed in size but erosion has appeared at the top of the tumor in one patient. The levels of serum gastrin in each patient did not vary and neither hepatic nor lymphatic metastasis was detected with abdominal CT. It was concluded that gastric carcinoid tumors associated with gastritis type A included some tumors that do not need to be removed immediately.