幽門輪を中心とする表層拡大型早期胃・十二指腸癌の1例

Superficial Extended Early Gastroduodenal Cancer of the Pyloric Ring, Report of a Case

要旨　患者は73歳の女性．心窩部不快感があり，胃・十二指腸X線検査および内視鏡検査で幽門部十二指腸球部の異常を指摘され来院した．内視鏡検査で幽門前庭部に白色調の平坦な隆起を認め，幽門輪は肥厚し，その一部に発赤した粘膜面が認められた．十二指腸球部にも粗大顆粒状で一部結節状の隆起を全周性連続性に認め，生検結果から腺腫内癌と診断し，十二指腸球部幽門側胃切除を施行した．切除標本では，病変は幽門輪を中心として，胃側に3.5cm，十二指腸側に3.5cm進展した広範な早期癌で，幽門輪の一部で粘膜下層（sm₁）への浸潤を認めた，病変部には広範にp53が過剰発現しており，幽門輪を中心とする表層拡大型胃癌と診断した．

　A 73-year-old female was referred to our hospital due to epigastric discomfort. Abnormalities in the pyloric duodenal bulb were detected by x-ray examination of the stomach and duodenum. And by endoscopic examination, a flat brown elevation was observed in the pyloric antrum and redness in the pyloric ring. In addition, a coarse granular elevation that was partly nodular was observed concentrically and continuously in the duodenal bulb. Biopsy specimen showed carcinoma in adenoma. The stomach and the duodenal bulb were resected. Resected specimens revealed extensive early carcinoma that centered on the pyloric ring and extended 3.5 cm on the gastric side and 3.5 cm on the duodenal side. Invasion to sm₁ was observed in a part of the pyloric ring. In the lesion, excessive and extensive expression of p53 was observed. Based on these findings, a diagnosis of superficial extended gastric cancer was made.