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Stomach and Intestine(Tokyo) Volume 52, Issue 13 （December 2017）

胃と腸 52巻13号（2017年12月発行）

Japanese English

早期胃癌研究会症例

胃型粘液形質を呈した0-IIc型早期直腸癌の1例 Early Rectal Cancer（0-IIc）with Gastric Mucin Phenotype, Report of a Case 中野尚子 ¹ , 高濱和也 ² , 塚本徹哉 ³ , 前田晃平 ¹ , 大森崇史 ¹ , 城代康貴 ¹ , 生野浩和 ¹ , 宮田雅弘 ¹ , 小村成臣 ¹ , 鎌野俊彰 ¹ , 田原智満 ¹ , 長坂光夫 ¹ , 中川義仁 ¹ , 柴田知行 ¹ , 大宮直木 ¹ Naoko Nakano ¹ , Kazuya Takahama ² , Tetsuya Tsukamoto ³ , Kohei Maeda ¹ , Takahumi Omori ¹ , Yasutaka Jodai ¹ , Hirokazu Ikuno ¹ , Masahiro Miyata ¹ , Naruomi Komura ¹ , Toshiaki Kamano ¹ , Tomomitsu Tahara ¹ , Mitsuo Nagasaka ¹ , Yoshihito Nakagawa ¹ , Tomoyuki Shibata ¹ , Naoki Ohmiya ¹ ¹藤田保健衛生大学消化管内科 ²高浜内科 ³藤田保健衛生大学病理診断科 ¹Department of Gastroenterology, Fujita Health University, Toyoake, Japan ²Takahama Internal Medicine Clinic, Nishio, Japan ³Department of Diagnostic Pathology, Fujita Health University, Toyoake, Japan キーワード：早期直腸癌 , 胃型粘液形質 , 0-IIc型 Keyword: 早期直腸癌 , 胃型粘液形質 , 0-IIc型 pp.1739-1747

発行日 2017年12月25日 Published Date 2017/12/25

DOI https://doi.org/10.11477/mf.1403201248

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要旨●患者は50歳代，男性．下部直腸に径25mm大の発赤の強い表面陥凹型腫瘍を認めた．NBI拡大観察でvessel patternは中央で網目・らせん状血管，辺縁で細い血管を認め，avascular areaは認めなかった．surface patternは不明瞭で，JNET分類Type 2Bと診断．クリスタルバイオレット染色拡大観察では，V_I型高度不整pit patternを認め，一部にI型pitが混在していた．患者本人の希望でESDを施行した．moderately differentiated tubular adenocarcinoma（tub2>por1>por2），pT1a（SM1，400μm），ly（−），v（−），pHM0，pVM1．MUC5AC，MUC6，pepsinogen IIが陽性で，胃型粘液形質を呈していた．直腸に占居し，かつ胃型粘液形質を呈し，低分化成分のあるLST-NG（0-IIc）病変は希少症例と考え，報告する．

　A 50-year-old man was referred to our hospital for the treatment of a tumor in the lower rectum, with 25mm diameter, reddish color, and slightly depressed shape. Magnifying narrow-band imaging showed net-like and spiral vessels at the center of the lesion and a dense network of thin vessels at the margin without an avascular area according to the JMET vessel pattern. The surface pattern was unclear and the diagnosis was JNET 2B. Magnifying chromoendoscopy with crystal violet staining showed a mixture of types I and VI severe. We recommended surgical resection, but on patient's request, we performed endoscopic submucosal dissection. On pathological examination, the endoscopically resected specimen was diagnosed as moderately differentiated tubular adenocarcinoma（tub2>por1>por2）, pT1a（SM1, 400μm）, ly（-）, v（-）, pHM0, and pVM1. Immunohistochemical staining showed that the specimen was positive for MUC5AC, MUC6, and pepsinogen II, thus indicating a gastric mucin phenotype.

　0-IIc lesions have been reported to commonly develop in the right side of the colon. Here we report a rare case of LST-NG（IIc）-type lesion that was located in the rectum and had poorly differentiated adenocarcinoma components, indicating the gastric mucin phenotype.