胃X線検診で発見されたHelicobacter pylori陰性噴門部進行胃癌の1例

Helicobacter pylori-Negative Advanced Gastric Cardia Cancer Detected with Stomach X-ray Examination, Report of a Case

要旨　患者は69歳，男性．胃X線検診で噴門部に異常を指摘され，精査目的で当センターを受診した．上部内視鏡検査では，噴門部に白苔を伴う深い潰瘍と辺縁に不整な陥凹面を認め，周囲には粘膜下層浸潤に伴うなだらかな周堤様隆起を認めた．生検組織診断では中～低分化型腺癌であった．精密X線検査は，腹部食道への浸潤と病変周囲の伸展不良所見が明瞭であり，Type 3と診断した．H. pylori除菌歴はなく，血清H. pylori抗体陰性（＜3U/ml），PG（pepsinogen）法陰性，病理組織像でもH. pylori菌は認められず，内視鏡像でも萎縮性変化を認めなかった．X線検診の基準撮影法1で撮影されたX線造影像では，粘膜像，ひだの性状，ひだの分布からH. pylori未感染と考えられる所見を呈していた．病理組織診断は，大きさ50×50mm，pType 3，pT4a（SE），moderately differentiated tubular adenocarcinoma，ly3，v2，pN3a，tub2＞por2＞tub1＞muc，large intestinal typeであった．Barrett食道は認めなかった．以上から，本症例は，H. pylori陰性の噴門部進行胃癌と診断した．

　The patient was a 69-year-old man who was referred to our centre for a detailed examination after an abnormality in the gastric cardiac region was noted in a stomach X-ray examination. The patient had no history of Helicobacter pylori（H. pylori）eradication, was negative for serum H. pylori antibodies（＜3）, was serum pepsinogen method-negative, and histopathological findings revealed no H. pylori bacteria. The patient was diagnosed with type 3 advanced gastric cancer with no atrophic changes based on the results of an upper endoscopy and a detailed X-ray examination. The histopathological diagnosis was large intestinal type moderately differentiated adenocarcinoma 50×50mm in size, ptype 3, T4a（SE）, ly3, v2, pN3a, tub2＞por2＞tub1muc. We were able to diagnose this patient as uninfected with H. pylori based on mucosal pattern, fold characteristics, and distribution with standard X-ray imaging technique 1.