stomal polypoid hypertrophic gastritis（SPHG）に発生したⅠ＋Ⅱb＋Ⅱc型早期胃癌の1例

Early Gastric Carcinoma, Type I + IIb + IIc Occurring in Stomal Polypoid Hypertrophic Gastritis, Report of a Case

要旨　胃潰瘍のためBillroth Ⅱ法の胃切除を受け，24年経過後残胃吻合部に，ほぼ半周性にⅠ＋Ⅱb＋Ⅱc型早期癌（高分化～低分化腺癌，sm）の発生をみた54歳，男性の症例を報告した．癌周囲を含む吻合部に吻合部肥厚性胃炎（stomal polypoid hypertrophic gastritis）の所見がみられ，癌は隆起部分（30×20mm）で塊状に粘膜下層に浸潤し，ⅡbやⅡc部分では主に粘膜上半分に存在していた．吻合部の胃炎性変化，すなわちgastritis cystica polyposaや，stomal polypoid hypertrophic gastritisを母地として発生したと考えられたこれまでの本邦報告例を一括し，本報告例と共にその臨床病理学的特徴を調べ，吻合部癌の組織発生について検討した．その結果，吻合部の胃炎性変化の表層上皮の未分化腺窩上皮からの癌化であることが示唆された．

　A 54 year-old man, who had undergone a partial gastrectomy followed by gastrojejunostomy (Billroth Ⅱ method) 24 years previously because of gastric ulcer, was admitted to our hospital with suspicion of gastric stump carcinoma. The upper gastrointestinal series and endoscopical examination revealed a protruding lesion in the anterior wall of the gastric remnant at the anastomotic site. Total gastrectomy with resection of the adjacent jejunal loop, and tail of the pancreas and splenectomy was carried out. Macroscopically, the resected stomach showed a polypoid lesion measuring 3.0 × 2.0 cm in the anterior wall of the anastomosis site. The parastomal gastric mucosa including the surrounding mucosa of the tumor showed moderate thickening with conspicuous areae gastricae. Histologically, the polypoid lesion was identified as moderately to poorly differentiated tubular adenocarcinoma extending superficially toward the lesser curvature along the anastomosis. Near the tumor there were elongation of the gastric pits due to hyperplasia of young foveolar epithelium, hyperylasia, and cystic dilatation of the pseudopyloric glands and their submucosal invasion. These lesions were identical with those of stomal polypoid hypertrophic gastritis. This case represents an early gastric carcinoma, type Ⅰ + Ⅱb + Ⅱc occurring in stomal polypoid hypertrophic gastritis.