Helicobacter heilmannii感染を認めたBarrett腺癌の1例

Barrett's Adenocarcinoma with Helicobacter heilmannii Infection, Report of a Case

要旨　患者は49歳，男性．主訴は心窩部痛．上部消化管内視鏡検査にて食道胃接合部に隆起性病変を認め，生検にて高分化型腺癌が疑われた．胃体上部大彎および前庭部大彎での迅速ウレアーゼ試験は陽性であった．また，胃体上部大彎，前庭部大彎および噴門部の生検組織標本にて，H. pyloriに比べ体長が長くらせん数の多いH. heilmanniiと考えられる菌体を認めた．組織学的胃炎は，胃体上部大彎，前庭部大彎の炎症細胞浸潤を軽度認めるのみであった．食道胃接合部の隆起性病変に対して，内視鏡的粘膜切除術を施行した．病理診断はadenocarcinoma（tub1），M，ly0，v0であり，病変肛門側の粘膜下層に固有食道腺を認め，Barrett食道由来の腺癌として矛盾しない所見であった．

　A 49-year-old male underwent endoscopic examination because of epigastralgia. Upper gastrointestinal endoscopic examination revealed an irregular and reddish elevation at the esophago-gastric junction. Biopsy specimens from the elevation demonstrated well differentiated adenocarcinoma. Rapid urease test was positive for both the antral and corpus specimens. In addition, Helicobacter heilmannii with its characteristic morphology, which is longer and more tightly spiraled in shape than that of H. pylori, was found in the mucosa of the antrum, corpus and cardia. Histological findings of the gastric biopsy specimen in the antrum and corpus mucosa showed mild infiltration of mononuclear cells. Endoscopic resection was performed for the elevated lesion. Histological findings of the endoscopic resected specimen showed well-differentiated adenocarcinoma restricted to the mucosa. Furthermore, esophageal gland was seen at the anal side of the lesion. Those findings were compatible with Barrett's adenocarcinoma.