内視鏡的ポリペクトミー後1年2か月の経過で再発をみたⅡc型早期胃癌の1例

Recurrence of Type Ⅱc Early Gastric Cancer 14Months after Endoscopic Polypectomy of Polypoid Cancer, Report of a Case

要旨　患者は66歳，男性．胃前庭部小彎のⅠ型早期胃癌に対し，内視鏡的に高周波ポリペクトミーを施行した．標本の組織学的検索ではcancer in adenoma，中分化型管状腺癌，深達度m，断端への癌浸潤（－）であったため，手術は不必要と判断した．切除後の経過観察中，1年2か月を経た胃内視鏡検査にて，同部に周囲隆起を伴う強発赤を認め，生検の結果，中分化型管状腺癌を認めた．ポリペクトミー標本と組織型が一致したため再発と診断し，胃切除術が施行された．病理組織学的には周囲隆起を伴うⅡC型早期胃癌，中分化型管状腺癌，深達度mであった．本症例ではポリペクトミー標本の見直し診断によって，隆起性病変のほぼ全体が癌であり，断端も片側で癌浸潤（＋）であった．内視鏡的組織切除に際しては，標本の十分な病理組織学的検索，および生検を含めた術後の頻回の経過観察が大切であり，癌組織の残存の可能性がある場合は，切除部周囲の焼灼術など，併用治療が有効であることを述べた．

　A 66-year-old male was admitted to our hospital and endoscopic polypectomy was done for type Ⅰearly gastric cancer on the lesser curvature of the stomach. Pathological diagnosis was"cancer in adenoma, moderately differentiated adenocarcinoma, no invasion to the cut margin".

　A year and two months later, type Ⅱcearly gastric cancer with surrounding elevation was detected next to the scar of prior polypectomy. We considered it recurrence because of the same pathological findings of the biopsy specimen and prior polypectomy specimen. Distal gastrectomy was performed. Macroscopically it was type Ⅱc early cancer surrounded by elevation. Pathologically it was moderately differentiated adenocarcinoma limited to the mucosal layer.

　Retrospectively, almost all of the polypectomy specimen were positive for cancer cells extending to the cut margin.This case suggests that detailed pathological examination of the cutmargin of resected specimen and frequent follow-up endoscopic examination with biopsy are very important. If extension of cancer is suspected, it is recommended to perform additional endoscopic coagulation therapy around the ulcer after the lesion is resected.