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Stomach and Intestine(Tokyo) Volume 54, Issue 2 （February 2019）

胃と腸 54巻2号（2019年2月発行）

Japanese English

今月の主題胃・十二指腸内視鏡拡大観察の基本と最新知見

主題症例

Helicobacter pylori未感染者の胃底腺粘膜に多発した低異型度胃型腺癌（腺窩上皮型）と腺窩上皮型過形成性ポリープの1例 Multiple Foveolar-type Adenomas and a Foveolar Hyperplasia in a Patient Not Infected with Helicobacter pylori, Report of a Case 福山知香 ¹ , 柴垣広太郎 ¹ , 三上博信 ¹ , 泉大輔 ¹ , 山下詔嗣 ¹ , 三代剛 ¹ , 大嶋直樹 ¹ , 石村典久 ¹ , 佐藤秀一 ¹ , 石原俊二 ¹ , 長瀬真実子 ² , 荒木亜寿香 ² , 石川典由 ² , 丸山理留敬 ² , 九嶋亮治 ³ , 木下芳一 ¹ Chika Fukuyama ¹ , Kotaro Shibagaki ¹ , Hironobu Mikami ¹ , Daisuke Izumi ¹ , Noritsugu Yamashita ¹ , Tsuyoshi Mishiro ¹ , Naoki Oshima ¹ , Norihisa Ishimura ¹ , Shuichi Sato ¹ , Shunji Ishihara ¹ , Mamiko Nagase ² , Asuka Araki ² , Noriyoshi Ishikawa ² , Riruke Maruyama ² , Ryoji Kushima ³ , Yoshikazu Kinoshita ¹ ¹島根大学医学部附属病院消化器内科 ²島根大学医学部附属病院器官病理学，病理部 ³滋賀医科大学臨床検査医学講座（附属病院病理診断科） ¹Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan ²Department of Pathology, Faculty of Medicine, Shimane University, Izumo, Japan ³Department of Clinical Laboratory Medicine and Diagnostic Pathology, Shiga University of Medical Science, Otsu, Japan キーワード：胃型腺癌 , 胃型粘液形質 , 腺窩上皮型 , Helicobacter pylori , 未感染胃癌 Keyword: 胃型腺癌 , 胃型粘液形質 , 腺窩上皮型 , Helicobacter pylori , 未感染胃癌 pp.265-272

発行日 2019年2月25日 Published Date 2019/2/25

DOI https://doi.org/10.11477/mf.1403201589

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要旨●患者はH. pylori未感染の30歳代，男性．内視鏡検査で胃体部に3mmの表面顆粒状小隆起を3病変認め，内視鏡的に切除した．2病変は鮮紅色でraspberry様の外観を呈し，NBI拡大像で異常血管が増生した絨毛様構造を認めた．病理組織学的にはMUC5AC陽性の完全胃型粘液形質を持つ低異型度胃型腺癌（腺窩上皮型）で，欧米でfoveolar-type adenoma/dysplasiaと記述されている組織型と考えられた．残り1病変は淡紅色を呈し，NBI拡大像で血管視認性が低い脳回様構造を認め，組織学的には腺窩上皮型過形成性ポリープであった．H. pylori未感染胃癌は全胃癌の1%以下とされるが，筆者らは14例20病変の低異型度胃型腺癌（腺窩上皮型）を経験し，全胃癌症例の6.6%（14/212）を占めており，内視鏡像は既報のfoveolar-type adenoma/dysplasiaとは全く異なっていた．

　A male patient in his thirties was examined by upper endoscopic screening. Three small protruding lesions were identified in the middle stomach. WLE（white-light endoscopy）revealed two lesions with a bright red fine granular surface and raspberry-like appearance. NBIME（narrow-band imaging with magnification endoscopy）showed a heterogenous villous microstructure with irregular capillaries. These two lesions were endoscopically resected and histologically diagnosed as foveolar-type adenomas〔adenocarcinoma in JCGC（the Japanese classification of gastric carcinoma）〕. The remaining one lesion was light red according to WLE and displayed a gyrus-like regular microstructure with invisible capillaries in NBIME. It was also endoscopically resected on suspecting neoplasia ; however, it was histologically diagnosed as foveolar hyperplasia. The patient was diagnosed as not having any current or previous infection of H. pylori（Helicobacter pylori）based on eradication history, H. pylori serum IgG antibody levels, urea breath test, and endoscopic and histological findings.

　Foveolar-type adenoma is a rare tumor that occurs in individuals without H. pylori infection and is diagnosed as adenocarcinoma in JCGC. Gastric cancer in individuals not infected with H. pylori reportedly accounts for <1% of all gastric cancers. However, we have identified 14 patients with foveolar-type adenoma（adenocarcinoma in JCGC）, which accounts for 6.6%（14/212）of all gastric cancer patients in our institution. The macroscopic findings of the tumors in this series were different from those of traditional foveolar-type adenomas reported in literature.