Helicobacter pylori除菌後スキルス胃癌を呈した鳥肌胃炎の1例

Nodular Gastritis Developed Schirrous Gastric Cancer following Successful Eradication of Helicobacter pylori, Report of a Case

要旨　患者は36歳，女性．婦人科手術前のスクリーニング目的で上部消化管内視鏡検査を施行し，鳥肌胃炎を認めた．鏡検法でH. pylori陽性を確認して除菌療法を施行し，2か月後に施行した尿素呼気テストで除菌成功を確認した．その後，除菌成功3年6か月後に心窩部痛を主訴に来院し内視鏡検査を施行したところ，胃体部原発のスキルス胃癌を認め，胃全摘術を施行した．病理組織学的には胃体下部大彎後壁の不整形潰瘍辺縁に低分化型腺癌を認め，同潰瘍部を原発巣とするlinitis plastica型胃癌の所見であった．鳥肌胃炎は胃体部の低分化型胃癌のハイリスク群と報告されているが，その実態や長期経過，さらには除菌療法後の経過など不明な点が多く，今後さらなる多数例，長期間での検討が望まれる．

　A 36-year-old female underwent an EGD（esophagogastricduodenoscopy）before a gynecologic operation. She was diagnosed as having nodular gastritis with H. pylori（Helicobacter pylori）infection as one of the histologic findings. Eradication therapy was performed and two months after, she was recognized as having achieved successful eradication by the urea breath test. Three years and six months later, after H. pylori eradication, she was refered to our institution with a complaint of epigastric pain. EGD disclosed schirrous gastric cancer, and total gastrectomy was performed. The pathological findings revealed poorly differentiated adenocarcinoma with linitis plastica type and the primary lesion was in the corpus. Nodular gastritis is reported to be at high risk of poorly differentiated adenocarcinoma at the gastric corpus. While, little is known about the current, long term follow-up status and the course after H. pylori eradication, further cases and long term follow-up studies are warranted.