文献詳細
今月の主題 微小胃癌の診断限界に迫る
主題症例
文献概要
要旨 〔症例1〕は,60歳代の男性.検診にて,胃体上部に発赤調陥凹性病変を散在性に認めた.NBI拡大観察にてWZの消失した不整な微細血管とDLを伴う3mm大の病変を1つ認めた.〔症例2〕は,70歳代の男性.胃癌EMR後にEGDを受け,胃体中部後壁に2mm大の発赤調陥凹を指摘された.NBI拡大観察ではDLと不整微細血管を有し,WZの消失した陥凹であった.〔症例3〕は,胃癌精査目的で紹介された50歳代の男性.近位前庭部大彎に多発する発赤を多数認めた.NBI拡大観察にて,後壁側の発赤調陥凹性病変内にWZの不整ないし消失,不整な微細血管およびDLを認めた.いずれの病変も分化型粘膜癌と診断し,生検を省略しESDにて切除した.組織学的にも治癒切除であった.
参考文献
1)Ezoe Y, Muto M, Uedo N, et al. Magnifying narrowband imaging is more accurate than conventional white-light imaging in diagnosis of gastric mucosal cancer. Gastroenterology 141 : 2017-2025, 2011
2)出口智子,田中信治,春間賢,他.いわゆる“ひとかき癌”との鑑別が問題となった肉眼所見陰性のIIb型小胃癌の1例.広島医 46 : 364-367, 1993
3)Yagi K, Nozawa Y, Endou S, et al. Diagnosis of early gastric cancer by magnifying endoscopy with NBI from viewpoint of histological imaging : mucosal patterning in terms of white zone visibility and its relationship to histology. Diagn Ther Endosc : article ID 954809, 2012
4)Yao K, Oishi T. Microgastroscopic findings of mucosal microvascular architecture as visualized by magnifying endoscopy. Dig Endosc 13 : S27-S33, 2001
5)Yagi K, Nakamura A, Sekine A. Comparison between magnifying endoscopy and histological, culture and urease test findings from the gastric mucosa of the corpus. Endoscopy 34 : 376-381, 2002
6)Yao K, Oishi T, Matsui T, et al. Novel magnified endoscopic findings of microvascular architecture in intramucosal gastric cancer. Gastrointest Endosc 56 : 276-284, 2002
7)Yagi K, Nakamura A, Sekine A, et al. Magnifying endoscopy with narrow band imaging for early differentiated gastric adenocarcinoma. Dig Endosc 20 : 115-122, 2008
8)Kobayashi M, Takeuchi M, Ajioka Y, et al. Mucin phenotype and narrow-band imaging with magnifying endoscopy for differentiated-type mucosal gastric cancer. J Gastroenterol 46 : 1064-1070, 2011
9)八木一芳,味岡洋一.胃の拡大内視鏡診断.医学書院,pp 63-75,2010
10)近裕,原田守久,上野正見,他.いわゆる「ひとかき癌」の3症例.Gastroenterol Endosc 28 : 3216, 1986
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