吻合部ポリープ状肥厚性胃炎に発生したⅠ型早期胃癌の1例

Type I Early Gastric Cancer Occurring in Gastritis Cystica Polyposa, Report of a Case

要旨　患者は58歳，男性．28年前（31歳時）十二指腸潰瘍で胃切除術，Billroth Ⅱ法再建術（結腸前，Brown吻合なし）を受けている．健診の目的で受診し，胃透視と胃内視鏡検査にて残胃吻合部に吻合部ポリープ状肥厚性胃炎（GCP）とⅠ型早期胃癌を見出し，残胃亜全摘術を施行した．病理組織学的には胃空腸吻合部前壁にⅠ型早期の高分化管状腺癌を認め，吻合部の肥厚性病変の部位は胃腺窩上皮の延長と過形成，偽幽門腺の増生，腺の囊胞状拡張，腺の粘膜下侵入といったGCPの特徴を有している．

　A 58-year-old man who had undergone Billroth Ⅱ gastrectomy due to duodenal ulcer 28 years ago, was admitted to our hospital because of type Ⅰ early gastric cancer. Barium meal study and endoscopical examination revealed a protruding lesion in the anterior wall of the remnant stomach along the gastrojejunostomy site. The biopsy specimen revealed adenocarcinoma and, subsequently, subtotal gastrectomy was carried out. Macroscopically, the resected specimen showed an annular protrusion with nodular surface of the gastric mucosa at the stomal site.

　Histologically, the protrusion beared the features of gastritis cystica polyposa, with hyperplasia and cystic dilatation of the pseudopyloric glands and their submucosal invasion. Well differentiated tubular adenocarcinoma was noted in the superficial mucosa at the most elevated portion of the anterior wall of anastomotic site. Based on these findings it is speculated that type Ⅰ early gastric cancer has probably developed from gastritis cystica polyposa.