胃と腸46巻9号

2011年08月発行

今月の主題 若年者の胃・十二指腸病変の特徴

主題

若年者胃癌の特徴―中高年に認める胃癌との相違─病理の立場から

著者： 平橋美奈子¹ 小田義直¹

所属機関： ¹九州大学大学院形態機能病理

ページ範囲：P.1308 - P.1315

文献概要

要旨　まず進行癌を含めた30歳未満の若年者胃癌65例と，41歳以上の胃癌115例の臨床病理学的事項と癌周囲粘膜の慢性胃炎の程度，次に30歳未満の粘膜内胃癌18例（全例低分化腺癌）と41歳以上の低分化粘膜内胃癌42例の背景粘膜を比較した．背景粘膜はthe updated Sydney system guidelines（1994）に従い，組織学的に評価した．結果，若年者には，女性（69.2％ vs. 36.5％，p＜0.001），低分化腺癌（84.6％ vs. 65.2％，p＝0.004）が多かった．癌周囲粘膜の比較では，若年者のH. pylori感染率は高く（81.5％vs. 20.9％，p＜0.001），より多くの好中球浸潤を認め（p＝0.028），固有腺の萎縮や腸上皮化生の程度は軽かった（p＜0.001）．粘膜内胃癌の背景粘膜の比較では，体部のH. pylori菌体密度が若年者で有意に高く（p＝0.0012），体部，前庭部ともに腸上皮化生の程度は低かった（p＜0.01）．また，若年者の前庭部粘膜にリンパ濾胞過形成を認めた（p＝0.005）．以上から，若年者胃癌は，女性，低分化腺癌が多く，背景に腸上皮化生を伴わず，前庭部のリンパ濾胞過形成を示すH. pylori感染性胃炎（鳥肌胃炎）を伴うことが多いことがわかった．

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