内視鏡的に2年間の経過観察で発見した進行胃癌の1例

Gastric Cancer Undetected in the Last Examination, Report of a Case

要旨●患者は60歳代，男性．スクリーニング目的の上部消化管内視鏡検査で胃体中部小彎に40mm大の0-IIa＋IIc＋I型病変を認めた．精密検査の結果，深達度T1b（SM）と診断し，腹腔鏡下幽門側胃切除術を施行した．病理組織学的診断では，0-IIa＋IIc＋I，42×28×6mm，tub1＋tub2≫pap>por，pT3（SS），INFb，Ly1c，V1b，pPM1，pDM0（120mm），pN2（5/22）で，リンパ節転移を認める進行癌であった．本症例は2年4か月前に人間ドックで受けた胃X線造影検査で胃体中部小彎のバリウム斑を指摘されたが，精密検査の内視鏡検査では異常所見なしと診断されていた．そのときの内視鏡像を振り返ると，血管透見良好な萎縮粘膜領域に淡い発赤調所見を認めていた．胃体部の観察では，小彎あるいは大彎を中心に観察を行い，前後壁を比較して異常所見を拾い上げることが重要である．

　A 60s man visited our outpatient department for esophagogastroduodenoscopy. Esophagogastroduodenoscopic findings revealed a 40mm sized 0-IIa＋IIc＋I type lesion in the middle gastric body. Then, laparoscopic distal gastrectomy was performed. The patient was histopathologically diagnosed with 0-IIa＋IIc＋I, 42×28×6mm, tub1＋tub2≫pap>por, pT3（SS）, INFb, Ly1c, V1b, pPM1, pDM0（120mm）, pN2（5/22）, advanced cancer with lymph node metastasis. Gastric X-ray imaging was done at the medical checkup 2 years and 4 months ago. A barium spot was noted in the mid-gastric body, but detailed endoscopy revealed no abnormalities. Looking back at the endoscopic image, a faint reddish tone was observed in the atrophic mucosal region with good vascular transparency. It is important to center lesser or greater curvature and compare the anterior-posterior walls when observing the gastrointestinal tract to identify abnormal findings.