H. pylori未感染胃上皮性腫瘍の内視鏡的特徴—ラズベリー様腺窩上皮型胃癌

Endoscopic Diagnosis of H. pylori Uninfected Gastric Epithelial Tumor：Raspberry-like Foveolar-type Gastric Adenocarcinoma

要旨●H. pylori未感染者のラズベリー様腺窩上皮型胃癌32例39病変の臨床病理学的特徴を検討し，8病変の全ゲノム解析を行った．年齢は中央値57（38〜78）歳，男女比は21：11，腫瘍は中央値3（1〜6）mm，すべてUM領域に発生し，6例は多発癌であった．白色光像ではいわゆるラズベリー様外観を呈し，NBI拡大像では不整な乳頭状/脳回様構造を呈した．すべて上皮内病変であったが，Ki-67 labeling indexは中央値62.0（4.4〜96.5）%と高値を示した．腫瘍数（多発vs. 単発）と背景因子の検討では，喫煙（83.3% vs. 34.6%，p<0.05），飲酒（66.6% vs. 30.7%，p＝0.12），男性（p＝0.059），胃底腺ポリープ併存（100% vs. 57.7%，p＝0.059）で多発癌を多く認めた．ゲノム解析ではKLF4遺伝子のDNA結合ドメイン内で共通するSNVsを認め，CNVsは半数以上で染色体1p，9q，17qでの増幅および6qや18qでの欠失を認めた．

　We analyzed clinicopathological characteristics of “Raspberry-like foveolar-type gastric adenocarcinoma” in H. pylori（Helicobacter pylori）-uninfected patients. Median patient age was 57 years（range, 38-78）, and male to female ratio was 21 to 11. All lesions occurred in the upper or middle part of the stomach, and 6 patients had synchronous multiple lesions. White-light endoscopy showed a “raspberry-like appearance”, and magnification endoscopy with narrow-band imaging showed irregularly shaped papillary or gyrus-like microstructures. All lesions were determined to be intraepithelial neoplasms, however Ki-67 labeling index was high, with a median value of 62%（range, 4.4-96.5%）. Multiple lesions were found more frequently than single lesion in smoking patients（83.3% vs. 34.6%, p<0.05）, patients who consumed alcohol（66.6% vs. 30.7%, p＝0.12）, male patients（p＝0.059）, and in patients with fundic gland polyps（100% vs. 57.7%, p＝0.59）.