ケイカチュウ ニ オウショク シュヨウ ケイタイ オ テイシタ ソウキ イガン ノ イチレイ

症例は63歳の男性,既往歴に30歳時胃潰瘍にて胃切除(Billroth II法), 60歳時肺癌で右肺下葉切除(低分化扁平上皮癌)がある.現病歴は右肺癌手術後の経過観察中にCEAの上昇を認め消化管精査を目的に当科紹介となった. 2001年5月の上部消化管内視鏡検査では胃噴門部後壁に白苔を有する隆起を認め,生検ではGroup IIIであった.以後経過観察となったが, 2003年5月には黄白色調の扁平隆起を呈し黄色腫類似の形態を呈し,生検ではGroup IVであった. 7月Group Vであり, 10月内視鏡的粘膜切除術が施行され病変は完全切除された.病理診断では管状腺癌であった.本症例は経過中に病巣表面が黄色腫類似の所見を呈した稀な症例であった.A 63-year-old man, who received gastrectomy for a peptic ulcer at 30 year-old and received pneumoresection for his undifferentiated squamous cell carcinoma of the lung at 60 years-old, was inspected by postoperative follow-up study. In May 2001, serum carcinoembryonic antigen level exceeded 5ng/ml, and he was referred to our department for endoscopic examinations. Endoscopic examination revealed a flat elevated lesion whose surface was covered with dense exudate on the posterior wall of the cardiac region, and the histopathological diagnosis was tubular adenoma. In May 2003, the flat elevated lesion was accompanied by yellow-whitish spots and endoscopically diagnosed as xanthoma, while the biopsy specimen from the elevated lesion demonstrated tubular ade noma with severe atypia. In October 2003, endoscopic mucosal resection was successfully completed for the lesion, and it was diagnosed as well differentiated adenocarcinoma. We consider that a gastric elevated lesion should be carefully followed when tubular adenoma is detected, even if endoscopically looks like benign xanthoma