H. pylori未感染の腸型分化型癌の1例

Helicobacter pylori Uninfected Intestinal-type Well-differentiated Adenocarcinoma in Early Gastric Cancer, Report of a Case

要旨●患者は60歳代，女性．前医の内視鏡検査で胃前庭部大彎に腫瘍径5mm大の発赤調の0-IIc型病変を認め，生検で高分化腺癌を認めたため，当院に紹介され受診となった．ME-NBI観察では陥凹部に一致してループ状の血管所見を認めた．内視鏡治療適応と診断し，ESDを施行したところ，病理組織学的結果は腸型の分化型癌であった．なお，内視鏡検査で胃体部〜胃角部にRACを認め，尿素呼気試験陰性，ペプシノーゲン法陰性，抗H. pylori抗体陰性であり，以上からH. pylori未感染腸型分化型癌と診断した．

　A woman in her 60s underwent EGD（esophagogastroduodenoscopy）at a local hospital, revealing a reddish 0-IIc lesion with diameter 5mm at greater curvature of antrum. Biopsy led to a diagnosis of well differentiated adenocarcinoma. At our hospital, loop pattern vessels were recognized in a depressed area using magnifying endoscopy with narrow band imaging. The lesion was diagnosed as a lesion with indication of endoscopic treatment, and endoscopic submucosal dissection was subsequently performed. From post-treatment pathology, the lesion was determined to be an intestinal-type well-differentiated adenocarcinoma. Moreover, because of the regular arrangement of collecting venules observed from gastric body to gastric angle, negative urease breath test, negative pepsinogen test and negative H. pylori antibody, the lesion was diagnosed as H. pylori-uninfected intestinal-type well-differentiated adenocarcinoma.