自己免疫性胃炎に合併した胃扁平上皮癌の1例—胃全摘・全割標本の検討を含めて

Gastric Squamous Cell Carcinoma with Autoimmune Gastritis Revealed by Total Gastrectomy and Whole-tissue Evaluation, Report of a Case

要旨●患者は70歳代，男性．大球性貧血の精査目的に施行したEGDを診断契機とし，精査の結果，進行最盛期の自己免疫性胃炎を背景とした進行胃癌（扁平上皮癌），早期胃癌（高分化管状腺癌，胃型形質）と胃神経内分泌腫瘍（NET）を認めた．胃全摘術を施行し切除標本を全割して病理組織学的に検討した結果，胃体部大彎前後壁を中心とした内分泌細胞微小胞巣（ECM）の分布が明らかとなり，NET（計4病変）はその分布領域内に位置していた．

　We present the rare case of a patient with autoimmune gastritis who underwent total gastrectomy, in whom whole-tissue evaluation revealed endocrine cell micronests and additional potential tumors. A man in his 70s who underwent endoscopy for anemia was referred to our facility with an ulcerative lesion of the anterior wall of the upper gastric body. Close examination led to the diagnosis of advanced-stage type 2 squamous cell carcinoma in the anterior wall of the upper gastric body, early-stage type 0-IIa＋IIc highly differentiated tubular adenocarcinoma in the lesser curvature of the middle gastric body, and two neuroendocrine tumor lesions in the greater curvature of the middle gastric body, associated with autoimmune gastritis. He underwent total gastrectomy, and the specimen was entirely split. The histopathologic examination of the whole tissue section revealed severe atrophy of the fundic gland area and multiple endocrine cell micronests in the anterior and posterior walls of the greater curvature of the gastric body. Two neuroendocrine tumors, which were not detected during preoperative examination, were also found.