胃と腸56巻10号

2021年09月発行

今月の主題 胃上皮性腫瘍—組織分類・内視鏡診断の新展開 主題

Epstein-Barrウイルス関連胃癌の新展開—Epstein-Barrウイルス関連胃癌の病理学

著者： 阿部浩幸¹ 日向宗利¹ 国田朱子¹ 牛久綾¹ 牛久哲男¹

所属機関： ¹東京大学大学院医学系研究科人体病理学・病理診断学

ページ範囲：P.1339 - P.1345

要旨●Epstein-Barrウイルス関連胃癌は胃癌の5〜10％を占め，男性に多く，胃体部・胃底部に好発し，残胃癌に占める割合も高い．病理組織学的には腫瘍内の豊富なリンパ球浸潤を特徴とし，典型例はリンパ球浸潤癌の像を示す．予後はその他の胃癌に比べ良好な傾向があり，早期癌におけるリンパ節転移はまれである．The Cancer Genome Atlas research networkによる分子分類4型のうちの一つに位置づけられ，高度なDNAメチル化や特徴的な遺伝子変異（PIK3CAやARID1Aなど）を有する．高頻度にPD-L1発現や遺伝子増幅を示し，抗PD-1抗体治療に高い感受性を示すなど，免疫治療の点からも重要な一群と考えられる．

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