びまん性粘膜下異所腺に合併した多発早期胃癌の1例

Multiple Early Gastric Cancers Associated with Diffuse Submucosal Ectopic Glands, Report of a Case

要旨　患者は73歳，男性．胃集検で体上部後壁に多発する隆起性病変を指摘され，精密検査を目的として来院．X線・内視鏡検査により，びまん性粘膜下異所腺に合併して早期胃癌3病巣と胃腺腫2病巣を発見した．胃全摘術を施行し，標本を全割して行った病理組織学的検索では胃腺腫の1病巣が高分化型腺癌に診断を改められ，早期胃癌4病巣と胃腺腫1病巣に加えて，微小Ⅱb3病巣が発見され，合計早期胃癌7病巣と胃腺腫1病巣が証明された．びまん性粘膜下異所腺の診療に際しては胃癌の合併，中でも多発胃癌に十分に注意する必要があると考えられた．

　A 73-year-old man was admitted to our hospital for more detailed evaluation of the multifocal elevated lelions in the upper part of the gastric body which were detected by gastric screening indirect x-ray examination. Upper GI direct x-ray and endoscopic examinations revealed three eariy gastric cancers (a type Ⅱa+Ⅱc lesion on the anterior wall of the gastric body, a type Ⅱc lesion on the posterior wall of the gastric body, and a type Ⅱa+Ⅱc lesion on the greater curvature at the opposite side of the angle), two adenomas (on the anterior wall of prepyloric region, and on the lesser curvature in the antrum), and several small to medium sized submucosal tumors.

　Total gastrectomy was performed and histological examination showed diffuse submucosal ectopic glands producing submucosal tumors, and three early gastric cancers being detected preoperatively (a type Ⅱa+Ⅱc lesion, sm, tub₂, anterior wall of the gastric body; a type Ⅱc lesion, sm, tub₂, posterior wall of the gastric body; a type Ⅱa+Ⅱc lesion, sm, tub₂, greater curvature at the opposite side of the angle). A lesion on the anterior wall of the prepyloric region being diagnosed as adenoma preoperatively was found to be a type Ⅱc early gastric cancer (m, tub₁). The other lesion on the lesser curvature in the antrum being diagnosed as adenoma was confirmed histologically. In addition to these lesions, three small type Ⅱb lesions were found on the posterior wall of the gastric body. Special attention should be paid for multifocal cancers in the case of diffuse submucosal ectopic glands in the stomach.