A型胃炎を背景にカルチノイドと早期胃癌を合併した1例

Combination of Early Gastric Carcinoma and Multiple Carcinoids Accompanied by Type A Gastritis, Report of a Case

要旨　患者は70歳代，女性．胃内視鏡検査でECJ直下に約1.5cm大の頂部が陥凹したSMT様隆起を認め，生検診断はカルチノイドであった．その対側の穹窿部後壁大彎よりに約2.5cm大の表面顆粒状を呈する隆起性病変を認め，生検診断は乳頭状腺癌とした．背景粘膜は逆萎縮性胃炎でH. pylori陰性であった．貧血は認めず，血中ガストリン値は6,190pg/mlと高値で抗胃壁細胞抗体も陽性であった．以上より，A型胃炎を背景に発生したカルチノイドと早期胃癌の合併例と診断し，胃全摘術を行った．病理組織学的所見ではカルチノイド（10mm，U，NET G1，曽我分類Type B，Rindi分類Type 1，深達度SM）および早期胃癌〔22×20mm，U，Type 0-I，pap，pT1a（M），ly0･v0，pN0，胃型粘液形質〕と診断した．両者の合併報告例は本邦5例目である．

　A 70-year-old woman underwent further examination for abdominal discomfort. Esophagogastroduodenoscopy showed a submucosal tumor with central depression at the lesser curvature of the upper gastric body and a reddish elevated lesion with papillary surface at the greater curvature of the fundus of the stomach. They were associated with fundic atrophic gastritis without antral atrophic change, and H. pylori was negative, malignant anemia negative, serumgastrin level 6,190pg/m, and anti-parietal cell antibody positive, suggestive of A type gastritis. Total gastrectomy was performed. We have diagnosed the combination of multiple gastric carcinoids（NET G1, Type B on Soga's classification, Type 1 on Rindi's classification）and early gastric carcinoma（C, 22×20mm, Type 0-I, papillary adenocarcinoma, pT1a（M）, ly0・v0, pN0, showing gastric phenotype）accompanied by A type gastritis. Our case is the fifth case of these combinations accompanied by type A gastritis in Japan.