胃と腸41巻7号

2006年06月発行

今月の主題 Helicobacter pyloriに起因しないとされる良性胃粘膜病変 主題症例

Helicobacter heilmannii感染を認めたBarrett腺癌の1例

著者： 大矢内幹¹ 大原秀一¹ 関根仁¹ 下瀬川徹¹

所属機関： ¹東北大学大学院医学系研究科消化器病態学

ページ範囲：P.1089 - P.1093

要旨　患者は49歳，男性．主訴は心窩部痛．上部消化管内視鏡検査にて食道胃接合部に隆起性病変を認め，生検にて高分化型腺癌が疑われた．胃体上部大彎および前庭部大彎での迅速ウレアーゼ試験は陽性であった．また，胃体上部大彎，前庭部大彎および噴門部の生検組織標本にて，H. pyloriに比べ体長が長くらせん数の多いH. heilmanniiと考えられる菌体を認めた．組織学的胃炎は，胃体上部大彎，前庭部大彎の炎症細胞浸潤を軽度認めるのみであった．食道胃接合部の隆起性病変に対して，内視鏡的粘膜切除術を施行した．病理診断はadenocarcinoma（tub1），M，ly0，v0であり，病変肛門側の粘膜下層に固有食道腺を認め，Barrett食道由来の腺癌として矛盾しない所見であった．

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