食道胃接合部領域の粘膜下腫瘍として発見されESDで切除された噴門腺過形成の1例

Cardiac Glands Hyperplasia of the Esophagogastric Junction, Report of a Case

要旨●患者は60歳代，女性．検診のEGDで，食道胃接合部に粘膜下腫瘍（SMT）様病変を認めたため，当院を紹介され受診となった．EUSでは第3層を主座とする低エコー層に包まれた1cm大のSMTで，その内部には高エコー，低エコー，無エコーが不均一に混在していた．ESDを行い偶発症なく病変を一括切除した．病理組織学的診断では，線維性隔壁で被覆された噴門腺の増生を認め，噴門腺過形成と診断した．噴門腺過形成は非常にまれな病変であり，本例はESDで一括切除することで，詳細な病理学的評価のもと噴門腺過形成と診断し得た貴重な症例と考えられた．

　A 60-year-old woman was referred to our hospital for further evaluation of a submucosal tumor located in the esophagogastric junction. Endoscopic ultrasound examination revealed that a lesion located at layer 3 contained hyperechoic, hypoechoic, and anechoic regions. We performed ESD（endoscopic submucosal dissection）as therapeutic diagnosis, without any complications. Histologically, hyperplasia of the cardiac glands was observed. The lesion was diagnosed as cardiac gland hyperplasia in the esophagogastric junction. Cardiac gland hyperplasia is a very rare lesion and is often difficult to diagnose using small specimens obtained by biopsy. In this case, en bloc resection of the lesion using ESD was useful to make an accurate diagnosis.