Stomal polypoid hypertrophic gastritis（SPHG）（gastritis cystica polyposa；GCP）に発生したⅠ型早期胃癌の1例

Early Gastric Carcinoma, Type Ⅰ, Occurring in Stomal Polypoid Hypertrophic Gastritis (SPHG)

　胃腸吻合部の胃側に発生したポリープ状の粘膜隆起性病変を，Nikolaiら¹⁷⁾（1965）とLittlerら¹³⁾（1972）はそれぞれgastritis cystica（囊胞状胃炎），gastritis cystica polyposa（GCP）（ポリープ状囊胞性胃炎）と呼称し，教室の古賀ら⁹⁾¹⁰⁾（1976）はstomal polypoid hypertrophic gastritis（SPHG）（吻合部ポリープ状肥厚性胃炎）と命名し報告している．しかし，SPHGは比較的少ない病変であり，その文献的報告は十数例を数えるにすぎず，そしてこの病変の中に明らかな癌巣の見られた報告はまだない．

　われわれは本病変を母地として発生したと考えられる1型早期胃癌の1例を経験したので，症例の概要ならびに病理学的所見に，若干の考察を加えて報告する．

　A 45-year-old man, who had undergone a partial gastrectomy followed by gastrojejunostomy (Billroth Ⅱ method) eighteen years previously because of gastric ptosis, was admitted to the hospital with suspicion of gastric stomal cancer. The upper gastrointestinal series revealed a protruding lesion in the posterior wall of the remnant stomach along the gastrojejunostomy site. The total gastrectomy with resection of the adjacent jejunal portion was carried out. Macroscopically, the resected specimen exhibited an annular protrusion with a more highly elevated portion showing nodular surface of the gastric mucosa at the anastomosis site. On histologic examination, the large areas of the protrusion were composed basically of elongation of the gastric pits due to hyperplasia of young foveolar epithelium, hyperplasia and cystic dilatation of the pseudopyloric glands and their submucosal invasion, the features identical with those of SPHG proposed by Koga et al. or of gastritis cystica polyposa (GCP) described by Littler et al. Besides these findings of SPHG, in the middle and deeper portions of the mucosa of the more elevated portion, there is an area of well differentiated adenocarcinoma with more poorly differentiated part in the superficial mucosa. This case represents an early gastric carcinoma, type Ⅰ, occurring in SPHG. To our knowledge, such instance has not previously been published.