内視鏡治療後4年間腫瘍形成がみられていないA型胃炎合併多発胃カルチノイドの1例

Multiple Gastric Carcinoid Tumor Associated with Type A Gastritis, Report of a Case Treated by Endoscopic Resection

要旨　患者は65歳，女性．検診目的にて上部消化管内視鏡検査を受け多発胃カルチノイドを指摘された．胃液検査では無酸症，血清ガストリン値は3,400pg/mlと異常高値を示し，抗胃壁細胞抗体は陽性で無酸症および高ガストリン血症を伴うA型胃炎合併多発胃カルチノイドと診断し内視鏡的粘膜切除術を施行した．病理学的には5mmの隆起性病変1個のみが腫瘍細胞が充実したカルチノイド腫瘍で，他に残存胃底腺粘膜による小隆起や平坦胃粘膜にECMが散在性にみられた．いずれも粘膜内に限局する病変であった．内視鏡治療後約4年が経過したがカルチノイド腫瘍の形成はなく，今回の治療は患者のQOLを含め適切であったと考えられた．

　A 65-year-old female was admitted for a further evaluation of multiple gastric carcinoids in the stomach while she was asymptomatic. Her serum gastrin level was remarkably high (3,400 pg/ml) and gastric parietal cell autoantibody was positive, but she was not anemic. Gastric secretion test demonstated complete achlorhydria. These findings suggested that the multiple gastric carcinoids in this patient were associated with Type A gastritis and hypergastrinemia. These small gastric tumors were excised endoscopically. The patient was followed up with endoscopy for four years and neither recurrence of tumor nor metastasis was not observed. This case was successfully treated with endoscopy and this evidence backed up the theory of minimum excision of the need for only multiple carcinoids associated with type A gastritis, which was proposed by Rindi or Gilligan in 1995.