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Stomach and Intestine(Tokyo) Volume 55, Issue 8 （July 2020）

胃と腸 55巻8号（2020年7月発行）

Japanese English

今月の主題 H. pylori未感染胃の上皮性腫瘍

主題研究

H. pylori未感染進行胃癌の臨床病理学的特徴 Clinicopathological Characteristics of Helicobacter pylori-Uninfected Advanced Gastric Cancer 吉田雄一朗 ^1,2 , 蔵原晃一 ¹ , 八板弘樹 ¹ , 大城由美 ³ , 南一仁 ⁴ , 浦岡尚平 ¹ , 池上幸治 ¹ , 平田敬 ¹ , 和智博信 ¹ , 松塲瞳 ¹ Yuichiro Yoshida ^1,2 , Koichi Kurahara ¹ , Hiroki Yaita ¹ , Yumi Oshiro ³ , Kazuhito Minami ⁴ , Shohei Uraoka ¹ , Koji Ikegami ¹ , Takashi Hirata ¹ , Hiroshi Wachi ¹ , Hitomi Matsuba ¹ ¹松山赤十字病院胃腸センター ²九州大学大学院病態機能内科学 ³松山赤十字病院病理診断科 ⁴松山赤十字病院外科 ¹Division of Gastroenterology, Matsuyama Red-cross Hospital, Matsuyama, Japan ²Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan ³Department of Pathology, Matsuyama Red-cross Hospital, Matsuyama, Japan ⁴Department of Surgery, Matsuyama Red-cross Hospital, Matsuyama, Japan キーワード： H. pylori , H. pylori未感染胃癌 , 進行胃癌 , A型胃炎 Keyword: H. pylori , H. pylori未感染胃癌 , 進行胃癌 , A型胃炎 pp.1061-1076

発行日 2020年7月25日 Published Date 2020/7/25

DOI https://doi.org/10.11477/mf.1403202096

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要旨●H. pylori未感染進行胃癌の特徴を明らかにする目的で，自験例の中で，食道胃接合部癌と残胃癌を除くH. pylori未感染胃癌を対象として抽出し早期胃癌と進行胃癌に分類したうえで，進行胃癌症例の臨床病理学的所見を早期胃癌との比較を含め遡及的に検討した．内視鏡的ないし外科的に切除された胃癌1,911例のうちH. pylori未感染胃癌は27例（1.4%）であり，そのうち進行胃癌は6例（全体の0.31%）であった．6例の平均年齢は59.3歳，男性4例，女性2例であり，A型胃炎の合併例を認めなかった．6例中4例が未分化型癌であり，粘液形質は胃型優位の胃腸混合型ないし胃型であった．肉眼型は明確な周堤形成が乏しいSMT様の様相を伴う3型進行癌が4例を占め，3例がL領域に位置していた．

　To evaluate the characteristics of H. pylori（Helicobacter pylori）-uninfected advanced gastric cancer, we screened 1911 samples of endoscopically or surgically resected gastric cancers for H. pylori-uninfected gastric cancer, excluding those with esophagogastric junctional cancer and remnant gastric cancer. Then, we classified the H. pylori-uninfected gastric cancer cases as either early or advanced cancer. The clinicopathological findings of the advanced cancer cases were retrospectively examined and compared with those of the early cancer cases. We identified 27（1.4%）cases of H. pylori-uninfected gastric cancer, of which six（0.31%）had advanced gastric cancer. The mean age of these six cases was 59.3 years ; they included four males and two females. Furthermore, no complications of type-A gastritis were observed. Of these, four cases showed undifferentiated adenocarcinoma, and the phenotypic expression was that of gastrointestinal mixed type, with a predominance of gastric type or gastric type. Based on macroscopic findings, four cases were classified as type-3 advanced cancer, with submucosal tumor-like features and poor marginal swelling, and three cases were located in the lower third.