Ⅱc類似進行型胃癌と併存した異所性胃粘膜から成る胃粘膜下腫瘍の1例

Coexistence of Submucosal Tumor Composed of Heterotopic Gastric Glands, Ⅱc-like Advanced Cancer and Multiple Scars of Ulcer in the Stomach, Report of a Case

　異所性の上皮成分の増生から成る胃粘膜下腫瘍としては，迷入膵が代表的な病変である．しかし本来の胃粘膜の迷入増生による胃粘膜下腫瘍の報告は少ない．

　われわれは，いわゆるⅡc類似進行型胃癌に併存した胃粘膜下腫瘍が，異所性に増生した偽幽門腺，胃底腺などの胃粘膜上皮より成り，化生性腸上皮も認められた症例を経験したので報告する．

　A 71 year-old man was admitted to our hospital because of weight loss about 7kg within a year. and endoscopic examination revealed in the stomach Ⅱc-like advanced cancer at the lesser curvature of the corpus, a subrnucosal tumor with central pit in the posterior wall near the greater curvature of the corpus and multiple scars of ulcer. So, proximal gastrectomy with dissection of regional lymph nodes. was performed.

　Macroscopically, the submucosal tumor was round and well demarcated protruded lesion about 1.5×1.5 cm in size covered with almost intact gastric mucosa. The cut surface showed that this tumor was localized in the submucosa and so many cysts were visible.

　Histologically, this tumor consisted of heterotopic gastric mucosa like foveolar epithelium, fundic gland and pseudopyloric gland. And the epithelial cells showing intestinal metaplastic change were also seen. The Ⅱc-like advanced cancer was composed of poorly to moderately differentiated adenocarcinoma invading into the proper muscle layer. The scars of ulcer proved to be Ul-Ⅱs. In addition to these lesions, several tiny nests of heterotopic gastric mucosa were found histologically in the submucosa.