Ⅱc型早期癌の型をみた高ガストリン血症随伴胃カルチノイドの1例

Gastric Carcinoid Accompanied with Hypergastrinemia Mimicking Early Gastric Cancer (Type Ⅱc), Report of Case

要旨　患者は42歳，女性．胃集団検診で胃角対側大彎の異常陰影を指摘され来院．血液検査にて血中ガストリンが730pg/mlと高値を示し，胃内視鏡にて同部位にⅡc様の数条のひだの集中を伴った潰瘍性病変を認めた．粘膜生検にて胃カルチノイドの診断を得て胃亜全摘術施行．摘出標本でもⅡc型早期胃癌との鑑別は肉眼的には困難であった．摘出標本の組織学的検索では典型的カルチノイドの所見を得，またGrimelius染色も陽性であった．術後経過は順調で血中ガストリンも正常に復し退院した．

　Gastric carcinoid is a rare disease, and we have found few cases which were diagnosed preoperatively. We report a case of gastric carcinoid with hypergastrinemia which was difficult to differentiate from an early gastric cancer (type Ⅱc) macroscopically. A 42-year-old female was referred to our hospital because of gastric abnormalities on screaning upper GI examination. Endoscopic examination revealed a lesion thought to be type Ⅱc gastric cancer on the greater curvature in the lower gastric body. Hypergastrinemia (730 pg/ml) was found. Macroscopic examination of the biopsy specimen, however, showed carcinoid. Subtotal gastrectomy was performed and her convalescence was uneventful. Her serum gastrin level returned to normal after the operation.