A case of early gastric cancer that developed 6 years after eradication of helicobacter pylori for nodular gastritis

症例は34歳,女性.2008年5月,空腹時の嘔気･下腹部痛を主訴に当院を受診した.上部消化管内視鏡検査で胃幽門部に鳥肌胃炎を指摘され,血液検査にて抗Helicobacter pylori IgG抗体が陽性であったため,除菌治療が施行された.除菌1ヵ月後の尿素呼気試験でHelicobacter pylori陰性となり,以降,上部消化管内視鏡検査は受けていなかった.除菌成功6年後の2014年1月に嘔気･嘔吐,下痢を認めたため,上部消化管内視鏡検査が施行された.胃体中部前壁に早期胃癌を認め,生検で未分化型癌が検出されたため,幽門側胃切除術･D2郭清･Billroth I法再建が施行された.病理組織学的には印環細胞癌で深達度SM2,複数の領域リンパ節転移を認めた.背景の胃粘膜に萎縮や炎症細胞浸潤,腸上皮化生は認めず正常の胃底腺粘膜であった.鳥肌胃炎は若年のHelicobacter pylori感染者に見られ,胃癌のハイリスク群と報告されているが,除菌治療後の経過などは不明な点が多い.鳥肌胃炎を認め除菌治療を行ったが,6年という長期経過後に早期胃癌を発症した1例を経験したため,若干の文献的考察を含めて報告する.

The patient was a 34-year-old female who visited our hospital in May 2008 for a chief complaint of nausea and lower abdominal pain upon fasting. Esophagogastroduodenoscopy(EGD)revealed nodular gastritis in the gastric antrum. Blood test showed positive for anti-Helicobacter pylori IgG antibody. We performed eradiation therapy for Helicobacter pylori. After eradiation therapy, urea breath test showed successful eradiation. 6 years after the successful eradiation, the patient visited our hospital again due to nausea/vomiting and diarrhea in January 2014. EGD indicated early gastric cancer on the anterior wall of the gastric middle body, and biopsy detected undifferentiated cancer. Distal gastrectomy, D2 dissection, and Billroth-I reconstruction were performed. Histopathological analysis revealed signet ring cell cancer with an invasion depth of SM2 and multiple regional lymph nodes metastases. Atrophy, inflammatory cell infiltrate, and intestinal metaplasia were not detected in the non-cancer mucosa.Nodular gastritis is observed in young patients with Helicobacter pylori infection, and can induce gastric cancer. However, the clinical course after eradication therapy is still unclear. We reported an example of early gastric cancer that developed after a long-term period(6 years)after eradication therapy in this report.

鳥肌胃炎

ヘリコバクター･ピロリ除菌治療

除菌後胃癌