Shirahige Akinori, Suzuki Haruhisa, Oda Ichiro, Sekiguchi Masau, Mori Genki, Abe Seiichiro, Nonaka Satoru, Yoshinaga Shigetaka, Sekine Shigeki, Kushima Ryoji, Saito Yutaka, Fukagawa Takeo, Katai Hitoshi
Akinori Shirahige, Haruhisa Suzuki, Ichiro Oda, Masau Sekiguchi, Genki Mori, Seiichiro Abe, Satoru Nonaka, Shigetaka Yoshinaga, Yutaka Saito, Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan.
World J Gastroenterol. 2015 Apr 14;21(14):4385-90. doi: 10.3748/wjg.v21.i14.4385.
An 80-year-old man was under annual surveillance esophagogastroduodenoscopy after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). Two years after the initial ESD, a 0-IIc type metachronous EGC lesion, 8 mm in size, without an ulcer scar, was found in the gastric antrum. The estimated tumor depth was up to the mucosa, and biopsy revealed well and poorly differentiated adenocarcinoma. ESD was performed for this lesion and en bloc resection with negative margins was achieved. Histopathological examination revealed an adenosquamous carcinoma 8 mm in size invading the deep submucosal layer (1600 μm), with lymphovascular invasion, consistent with the diagnosis of non-curative resection. Additional gastrectomy was recommended for this patient; however, two months after the ESD, preoperative computed tomography revealed multiple liver metastases, and the patient was considered as an unsuitable candidate for surgical resection. Systemic chemotherapy was therefore started; however, the patient died of gastric cancer 27 mo after the second ESD. Early gastric adenosquamous carcinoma localized to the mucosa and submucosa is extremely rare and its clinical behavior is not well known. The present report is very significant in that it underscores the distinct possibility of gastric adenosquamous carcinoma being very aggressive and fatal even when detected at an early cancer.
一名80岁男性在接受早期胃癌内镜黏膜下剥离术（ESD）后接受年度食管胃十二指肠镜检查监测。初次ESD术后两年，在胃窦发现一个大小为8 mm的0-IIc型异时性早期胃癌病变，无溃疡瘢痕。估计肿瘤深度达黏膜层，活检显示高分化和低分化腺癌。对该病变进行了ESD，实现了切缘阴性的整块切除。组织病理学检查显示为一个大小为8 mm的腺鳞癌，侵犯深层黏膜下层（1600μm），伴有脉管侵犯，符合非根治性切除的诊断。建议该患者进行额外的胃切除术；然而，ESD术后两个月，术前计算机断层扫描显示多发肝转移，该患者被认为不适合手术切除。因此开始全身化疗；然而，患者在第二次ESD术后27个月死于胃癌。局限于黏膜和黏膜下层的早期胃腺鳞癌极为罕见，其临床行为尚不清楚。本报告非常重要，因为它强调了胃腺鳞癌即使在早期癌症阶段被发现也极具侵袭性和致命性的明显可能性。
