キサントーマ細胞を伴ったⅡa型残胃早期癌の1例

Ⅱa Type Early Gastric Carcinoma with Xanthoma in the Gastric Remnant, Report of a Case

要旨　患者は73歳，女性．16年前に胃ポリープで胃広範囲切除を受け，Billroth Ⅰ法で再建されていた．7か月前より胃部不快感があり来院した．内視鏡検査にて残胃大彎側に境界明瞭な黄白色調を呈する扁平隆起性病変を認めた．肉眼的形態はキサントーマに類似していたが，中心部表面は不整な凹凸と発赤を伴っており，Ⅱa型早期癌と診断した．切除標本では2.6×1.8cmのⅡa型早期癌で，深達度mの管状腺癌であったが，粘膜の癌病巣の範囲に一致して粘膜固有層には多数の泡沫細胞を認め，キサントーマ細胞であった．癌とキサントーマの関係は明らかではないが，黄白色を呈した内視鏡所見と共に特異な組織学的所見が認められた．

　The patient was a 73-year-old woman who had undergone Billroth I gastrectomy 16 years before due to gastric polyp. She had a feeling of upper quadrant discomfort for seven months prior to admission. Endoscopic examination revealed a protruding lesion on the greater curvature of the remnant stomach. The surface of the lesion was yellowish, nodular and partially reddish (Figs. 2 and 3). It looked like xanthoma of the stomach. Examination of biopsy specimens showed adenocarcinoma with infiltration of xanthoma cells. Total resection of the remnant stomach was performed on January 17, 1986. Histology of the lesion, 26×18 mm in diameter, was Ⅱa type early cancer located in the mucosa. Xanthoma cells were found only in the cancer lesion (Figs. 5 and 6).

　Carcinogenecity of xanthoma was strongly suggested in this case.