早期胃癌ESD治癒切除（eCura A）から3年5か月後にリンパ節転移再発を来した1例

Lymph Node Metastasis after Gastric ESD Curative Resection（eCura A）, Report of a Case

要旨●患者は70歳代，女性．上部消化管内視鏡検査で幽門輪近傍の胃前庭部前壁を主座とする，中心に陥凹を伴う丈の低い平坦隆起性病変を指摘された．生検でtub1，早期胃癌の診断で精査加療目的に当院へ紹介となった．当院での精査の結果，ESDの適応拡大病変（現在のガイドラインにて絶対適応病変）と判断し2011年9月にESDが施行された．病理組織学的にはサイズは37mm，組織型はtub1，深達度はM，pUL0，脈管侵襲および断端陰性で適応拡大治癒切除（現在のガイドラインにて治癒切除：eCura A）と診断した．以後定期的な内視鏡検査は施行されていたが，遺残再発および異時多発病変は認めなかった．しかし，ESDから3年5か月後に腹部超音波検査およびCTで腹腔内リンパ節再発が指摘された．明らかな原発巣は指摘されず，早期胃癌ESD後のリンパ節転移再発と診断した．eCura Aを達成したESD症例において再発例の報告は非常に少なく，文献的考察を加えて報告する．

　A woman in her 70s who was detected with a flat elevated lesion with shallow depression in the anterior wall of the gastric antrum near the pyloric ring was diagnosed with EGC（early gastric cancer）and was referred to our department. Based on our examinations, the lesion was diagnosed as an expanded indication lesion of the ESD（absolute indication lesion of ESD in the latest guideline） ; we performed ESD in September 2011. The pathological result showed expanded indication curative resection（curative resection：eCuraA in the latest guideline）because of the size ; 37mm, histological type ; tub1, depth ; M, pathological UL0, negative vascular invasion, negative margin. After the ESD, follow-up was performed with regular endoscopy ; however, no residual recurrence or new lesion was observed. However, three years and five months after the ESD, abdominal ultrasonography and CT scan showed abdominal lymph nodes metastasis. No primary lesion was recognized ; therefore, we established a diagnosis of recurrent lymph node metastasis of EGC and performed ESD. Almost no recurrence is observed in the case of eCuraA, then we report the case with a review of the literature.