丈の高い粘膜下腫瘍様隆起を呈した胃底腺型胃癌の1例

Gastric Adenocarcinoma of Fundic Gland Type with a Highly Elevated Gross Shape, Report of a Case

要旨●患者は70歳代，男性．胃体上部前壁に30mm大で，軟らかくSMT様を示す扁平隆起性病変（0-IIa型）を認めた．内視鏡所見と生検病理診断の結果から胃底腺型腺癌cT1bN0M0 Stage IAと診断し，腹腔鏡下噴門側胃切除，D1＋郭清術を施行した．病理組織学的には主細胞分化や副細胞分化を示す腫瘍細胞から成る胃底腺型腺癌で，粘膜深層から粘膜下層浅層に主座を置いていたが，粘膜下層深層では腫瘍腺管の囊胞状拡張が目立ち，腫瘍の厚みを形成する要素の一つと考えられた．また，腫瘍近傍の粘膜下層間質にはやや浮腫状の変化を認め，結果として軟らかく丈の高い隆起が形成されたと考えられた．以上，丈の高い扁平隆起を呈した胃底腺型胃癌の1例を経験したので報告した．

　A 70-year-old man presented with a 30mm lesion located in the anterior wall of the upper gastric body. The tumor had a highly elevated gross shape and subepithelial tumor-like appearance. Based on endoscopic and histologic evaluation of biopsy specimens, the patient was diagnosed with gastric adenocarcinoma of fundic gland type（cT1bN0M0 stage 1a）. Thus, we performed laparoscopic proximal gastrectomy with lymph node dissection（D1＋）.

　Histopathological studies revealed that the tumor extended from the deep mucosa to the shallow submucosa, and the main characteristic of the tumor was the presence of chief or mucous neck cells. The tumor thickness and soft and highly elevated appearance were attributed to the cystically dilated tumor glands and submucosal edema accompanying inflammation.