ESDで診断した噴門部進行胃癌の1例

Differentiated Type Infiltrative Gastric Cancer Diagnosed by Endoscopic Submucosal Dissection, Report of a Case

要旨●70歳代，男性．嚥下困難を主訴に前医を受診し，EGDで食道アカラシアが疑われ他院に紹介された．他院では噴門部胃癌の可能性を指摘された．EGDを再検し，噴門部病変から生検したがGroup 1であった．EUS-FNAの病理組織学的検査では腺管を認めるが，異型に乏しく癌と診断されなかった．粘膜切開生検はGroup 2で確定診断できず，当院へ紹介され受診となった．当院EGDでは，噴門部前壁に凹凸不整な発赤粘膜，壁の硬化像を認め，4型進行癌が疑われた．診断的なESDで管状腺癌と診断され，腹腔鏡下噴門側胃切除術を実施した．4型，70×70mm，tub1，pT4a（SE），INFc，Ly0，V1c，pCY1，pPM1，pDM0，Stage IVであった．

　A man in his 70s presented to a previous hospital with dysphagia. Contrast gastroradiography revealed esophagogastric junction stenosis, which was suspected to be achalasia. Esophagogastroduodenoscopy revealed a 50mm localized reddish lesion at the cardia which is suspicious for infiltrative cancer. Forceps biopsy specimens from the lesion were diagnosed as chronic gastritis. Endoscopic ultrasonography（EUS）demonstrated muscularis propria thickening. EUS-guided aspiration biopsy was performed but did not indicate cancer diagnosis. The mucosal incisional forceps biopsy exhibited several glands in the submucosa, but the biopsy was considered indefinite for neoplasia as the glands demonstrated only low degrees of cellular atypia. A small part of the lesion was excised with the endoscopic submucosal dissection technique after the patient's reference to our hospital. A 70mm specimen contained the submucosa which was infiltrated with cancerous glands.