A型胃炎に合併した胃癌症例の特徴

Clinicopathological Features of Gastric Cancer in Patients with Autoimmune Gastritis

要旨●最近12年間に当科で診断したA型胃炎症例の中で，胃癌を合併した20例（23病変）を対象とし，その臨床病理学的所見を遡及的に検討した．対象の平均年齢は76.6歳，男性9例，女性11例で，7例に悪性貧血の合併を認めた．胃癌23病変の大部分は胃体部に発生した隆起型の高分化型腺癌であり，扁平上皮癌の1病変を除く22病変はすべて早期胃癌であった．半数以上は胃型の粘液形質を有し，胃底腺型胃癌や扁平上皮癌なども存在した．胃癌を合併していない自験A型胃炎症例と比較して，胃過形成性ポリープの合併が多く，胃体部の病理組織学的な慢性炎症細胞浸潤や萎縮の程度が強い傾向があり，胃癌合併例はA型胃炎晩期の特徴を有していた．

　In order to clarify the clinicopathological features of 23 gastric cancers in 20 patients with autoimmune gastritis, we retrospectively investigated 95 patients with autoimmune gastritis for 12 years. Most subjects had differentiated adenocarcinoma of the elevated type in the gastric corpus. Twenty-two lesions except SCC were early gastric cancers. More than half the lesions had gastric type of mucus phenotype. Among 23 lesions, three were gastric adenocarcinoma of the fundic gland type, and one lesion was SCC. Patients with gastric cancers tended to have more gastric hyperplastic polyps and stronger degree of chronic inflammation and atrophy of the gastric corpus.