孤立性胃粘膜下異所腺に発生した早期胃癌の1例

Early Gastric Cancer Associated with Solitary Submucosal Heterotopic Gastric Glands, Report of a Case

要旨　患者は48歳，男性．糖尿病で通院中，上腹部痛のため上部消化管内視鏡検査を施行した．胃体下部大彎にⅡa＋Ⅱ様の病変を認め，生検で中分化型腺癌と診断され胃亜全摘術を行った．病理組織学的には腫瘍組織は腸上皮化生のない胃底腺領域に存在する分化型腺癌で，腫瘍辺縁部の粘膜下層に，異型性を欠く異所腺を認め，腫瘍組織との間にフロント形成が認められた．他部位に異所腺は認めず，孤立性胃粘膜下異所腺から発生したと考えられた．

　A 48-year-old man who had diabetes mellitus was admitted to our hospital because of epigastralgia. Endoscopic examination with biopsy revealed an early gastric cancer of type Ⅱa+Ⅱc lesion on the greater curvature of the body. Microscopical examination disclosed moderately differentiated tubular adenocarcinoma and a proximal gastrectomy was therefore performed.

　Histological findings showed that early gastric carcinoma was localized in the fundic gland area without intestinal metaplasia, and the heterotopic gastric glands with no evidence of cytologic or histologic malignancy were able to be seen at the peripheral lesion of the submucosal layer. A contact point was revealed between the neoplastic cells and the non-neoplastic cells in the heterotopic gastric glands. No submucosal heterotopic gastric glands other than the present lesion were observed in the stomach. Therefore, we concluded that a solitary submucosal heterotopia of the stomach could be considered to have a specific relationship to gastric carcinogenesis.