Helicobacter pylori除菌後に発見されたスキルス胃癌の1例

Scirrhous Gastric Cancer Detected after Helicobacter Pylori Eradiation, Report of a Case

要旨●患者は50歳代，男性．5年前にH. pyloriの除菌療法を受け，その後毎年上部消化管内視鏡検査（EGD）によるフォローを受けていた．除菌5年後に施行したEGDにて4型進行胃癌を指摘され当院に紹介となった．内視鏡所見では，びらんを伴う粘膜ひだの腫大が胃体部大彎を中心に認められた．審査腹腔鏡にてCY0P0であったことから，開腹胃全摘術が施行された．病理診断結果を含めた術後最終診断はT4aN3bM0 ; fStageIIIcであった．病変指摘の1年前に施行したEGDを見なおしたが腫瘍性病変を疑う所見は指摘できなかった．未分化型腺癌におけるH. pylori除菌後の臨床的特徴は明らかではなく，H. pylori除菌後4型進行胃癌の報告は非常に少ない．本症例は1年ごとのサーベイランスを受けていたにもかかわらず4型進行胃癌として発見された留意すべき症例であり文献的考察を加えて報告する．

　A 50-year-old male underwent H. pylori（Helicobacter pylori）eradication treatment five years ago and every year after that treatment, he was undergoing follow-up by EGD（esophagogastroduodenoscopy）. Five years after the eradication of H. pylori, the EGD reports revealed advanced type 4 gastric cancer, and thus he was referred to our hospital. The endoscopic reports showed swelling of the mucosal fold with erosion mainly at the greater curvature of gastric body. Staging laparoscopic examination revealed CY0P0, and total gastrectomy was performed. Microscopic examination revealed T4aN3bM0 ; pStage IIIc. Although EGD was performed one year before the cancer was indicated, no indications of neoplastic lesion could be detected. Clinical characteristics of undifferentiated-type carcinoma after H. pylori eradication are uncertain. Moreover, there are very few reports of scirrhous gastric cancer cases after H. pylori eradication. This is an important case in which advanced type 4 gastric cancer was pointed out despite yearly monitoring.