胃粘膜・領域リンパ節にサルコイド肉芽腫を伴った早期胃癌の1例

Early Gastric Cancer with Sarcoid-like Reaction in Gastric Mucosa and Regional lymph Node, Report of a Case

要旨　患者は50歳代，女性．近医で施行された上部消化管内視鏡検査（EGD）で胃に病変を認め，当院へ紹介受診となった．EGDで前庭部大彎に30mm大のひだ集中を伴う褪色調陥凹性病変を認め，生検では低分化腺癌を伴う中分化管状腺癌であった．また胃体上部大彎，胃体下部大彎に黄白色調の陥凹性病変を認め，生検では類上皮様細胞を伴う肉芽腫の形成を認めた．領域リンパ節の腫大を認めたが，明らかな遠隔転移はなく，幽門側胃切除＋D2廓清術が施行された．病理結果はpType 0-IIc，37×29mm，tub2＞por2＞sig，pT1b（SM2 ; 1,500μm），ly1，v0，INFb，int，pPM0，pDM0，pStage IAであり，領域リンパ節に転移所見は認めなかったが，胃粘膜と領域リンパ節にサルコイド肉芽腫を認めた．

　A 54-year-old woman was diagnosed with gastric disease at a nearby hospital and presented to the National Cancer Center Hospital East. Esophagogastroduodenoscopy showed a discoloration, depressive lesion of 40mm in diameter with fold convergence at the greater curvature of the gastric antrum. Moderately differentiated adenocarcinoma with poorly differentiated adenocarcinoma was detected at biopsy specimen and we diagnosed as Type 0-IIc early gastric cancer infiltrating onto SM deep layer. The depressed yellow lesions were detected in the whole stomach, magnifying endoscopy with narrow band imaging revealed dilated and tortuous vessels, while no tumor vessels were found. The formation of granuloma with epithelioid cells was shown in the biopsy specimen. Although the enlargement of the regional lymph nodes was detected in abdominal CT, the findings of clear distant metastasis were absent. After distal gastrostomy and with D2 lymph node dissection were performed, the pathological examination revealed a pType0-IIc, 37×29mm, tub 2＞por2＞sig, pT1b（SM2 ; 1,500μm）, ly1, v0, INFb, int, pPM0, pDM0, pStage IA. No metastatic findings were found in regional lymph nodes, but gastric mucosa and regional lymph node showed a sarcoid granuloma. There are few reports that showed not only regional lymph node, but also a sarcoid granuloma to gastric mucosa and presented with an endoscope image specific in gastric cancer. This is the reason why we report this case with reference to the literature.