残胃噴門部にみられた低分化型粘膜内癌の1例

Poorly Differentiated Adenocarcinoma Confined to the Mucosa in the Cardiac Region of the Remnant Stomach, Report of a Case

要旨　患者は65歳，女性．上腹部痛を主訴に当院を受診し，上部消化管内視鏡検査で残胃噴門部の異常を指摘され，精査目的で入院となった．上部消化管内視鏡検査では，残胃噴門小彎に色調の変化に乏しい小さな隆起性病変がみられた．色素撒布で隆起周囲に表面粗な平坦な病変が観察された．同部からの生検で低分化型腺癌と診断された．胃X線検査では同部は辺縁不整な淡いバリウムのたまりとして描出された．残胃にみられた噴門部早期胃癌と診断され，残胃全摘術が施行された．病理診断は低分化型腺癌，深達度はmであった．噴門部低分化型早期胃癌の報告は少なく，噴門部癌の発育・進展を考える上でも貴重な症例である．

　A 65-year-old female visited our hospital complaining of upper abdominal pain. Gastrofiberscopy revealed a reddish elevated lesion on the posterior wall in the cardiac region of the remnant stomach. After spraying it with indigo carmine solution, a rough surfaced flat lesion was recognized. Histological studies on the biopsy specimen revealed a poorly differentiated adenocarcinoma. X-ray examination shows localized barium deposits with irregular margins on the lesser curvature and two radiolucent areas at the center and posterior edge of the barium deposits in the half-standing supine, left anterior oblique projection. Total gastrectomy of the remnant stomach was carried out. Pathological studies of the resected specimen revealed a poorly differentiated adenocarcinoma, type0-IIc, pT1, N0, M0p Stage I, ly0, v0. This is an instructive case for considering the progression of cardiac cancer of the stomach.

　1) Department of Gastroenterolgy, Nanpuh Hospital, Kagoshima, Japan