早期胃膠様腺癌の1例

An Early Gastric Mucinous Adenocarcinoma, Report of a Case

要旨　患者は61歳，男性．1992年2月胃精密検査のため紹介された．胃内視鏡検査および胃X線検査で，胃前庭部前壁に表面に不整な多発びらんを伴う軽度の隆起性病変を認めた．腫瘍の辺縁は粘膜下腫瘍の形態を示していた．前庭部のびらん部からの生検で膠様腺癌の所見が得られた．1992年4月16日，胃亜全摘術が施行された．病理組織学的には胃膠様腺癌で癌細胞は粘膜下層までに限局していた．腫瘍は粘膜下層に主座を持ち，同部に多量に浸潤していた．本症例においては7か月前に内視鏡検査が行われており，胃前庭部にびらん性胃炎の所見が認められた．胃膠様腺癌は深部に浸潤した場合，粘液産生能を獲得すると言われている．早期胃膠様腺癌はまれな胃癌で，ときに特異な形態を示すことがあり，貴重な症例と考え報告した．

　A 61-year-old man was referred to our hospital for more detailed examination of the upper gastrointestinal tracts in February 1992. Endoscopic and x-ray examinations revealed a smoothly elevated lesion and multiple erosions with an irregular margin in the gastric antrum. The margin of the tumor resembled that of a submucosal tumor. Biopsy specimen from the antral erosion showed mucinous adenocarcinoma. Subtotal gastrectomy was performed on April 16, 1992. Histopathologically, the lesion was mucinous adenocarcinoma which was limited within the submucosal layer. The main part of the tumor was located in the submucosal layer. There was neither lymph node nor distant metastasis.

　In this case, endoscopic examination 7 months precending admission showed erosive gastritis in the gastric antrum. Mucinous adenocarcinoma may acquire mucin producing function at the same time when it invades the undelying layers. Early gastric mucinous adenocarcinoma is the least common type among adenocarcinomas of the stomach and shows sometimes unusual macroscopic appearance.