胃ポリープの癌化例

Cancerous Change of Gastric Polyp, a Case Report

　患者：W. G.　69歳男

　家族歴および既往歴：特記すべきものはない．

　現病歴および臨床経過：自覚的に消化器症状はなかったが，昭和44年12月胃集団検診を受けたところ，幽門前庭部に陰影欠損状の所見と十二指腸球部の変形が指摘された．昭和45年2月に直接X線検査を行ない幽門前部に陰影欠損像がみられ，ついで施行したGTFでは幽門前部に有茎性の胃ポリープが認められ，同時に行なった生検細胞診では癌細胞陰性であった．

　A man 69 years of age, free from any symptoms related to the digestive tract, had undergone gastric mass screening in Dec. 1969, when a shadow defect had been noticed in the pyloric antrum. Subsequent x-ray examination led to a diagnosis of a pedunculated, very mobile polyp of the stomach. Endoscopy also revealed a reddened polyp with a stalk in the pyloric antrum on the posterior wall in the side of the greater curvature.

　As cytodiagnosis at the initial endoscopy was negative for cancer, we kept on following him up. Gastric biopsy in Nov. 1970 revealed gastric tubules with marked cellular atypia. They were hard to distinguish from regenerated epithelium. Gastrectomy was thus performed one year and six months after the initial examination.

　Resected stomach showed a pedunclated dark red polyp, 1.7×1.2×1.3 cm in dimensions, near the pyloric ring in the antrum. Histologically, it was a hyperplastic polyp with cells of tubular adenocarcinoma in a part of the tip of the tumor.