ESD適応拡大治癒切除後にリンパ節転移および肝転移再発を来した早期胃癌の1例

A Rare Case of Early Gastric Cancer with Lymph Node and Liver Metastasis Following Curative Resection of Endoscopic Submucosal Dissection

要旨　患者は81歳，男性．2013年2月に胃体下部後壁の隆起性病変に対してESD（endoscopic submucosal dissection）を施行した．病理診断は48mmの0-I型分化型粘膜内癌で，適応拡大治癒切除であった．15か月後の腹部超音波検査と腹部造影CT検査で2か所の肝転移と，胃の小彎リンパ節転移を疑う所見を認めた．PET-CTでも同部位に集積がみられたが，他の原発を疑う所見は認めなかった．画像所見と経過よりESD治癒切除後の転移再発と診断した．追加の病理検索でも明らかな非治癒因子は検出されなかった．本稿では，ESD治癒切除後にリンパ節，肝転移再発を来したまれな早期胃癌の症例について報告する．

　In this case report, we report a rare case of EGC that caused lymph node and liver metastases after curative resection using ESD. A 81-year-old man was admitted to our hospital to undergo ESD（endoscopic submucosal dissection）of EGC（early gastric cancer）in February 2013. The lesion was grossly protruding and was 48mm in size. Pathologically, the lesion showed well-differentiated adenocarcinoma that localized to the mucosal layer without ulceration. The horizontal and vertical margins of the lesion were negative for cancer. The lesion was diagnosed as a curative resection within the expanded indication of ESD. Upon a 15 month follow-up, lymph node and liver metastases were detected by abdominal ultrasonography and computed tomography. Positron emission tomography-computed tomography did not reveal any other primary lesion that caused the metastases. He was diagnosed with lymph node and liver metastases of EGC. We evaluated the resected specimen by additional deeper cutting ; however, we could not find any noncurative pathological finding in the resected specimen.