Hayashi Jiro, Yamatsuji Tomoki, Suehiro Mitsuhiko, Haruma Ken, Katsumata Ryo, Kawamoto Hirofumi, Kamada Tomoari, Yoshida Kazuhiro, Yoneda Masamichi, Monobe Yasumasa, Naomoto Yoshio
Department of General Surgery, Kawasaki Medical School General Medical Center, Okayama, Japan.
Department of General Internal Medicine 2, Kawasaki Medical School General Medical Center, Okayama, Japan.
Case Rep Gastroenterol. 2022 Jun 7;16(2):345-350. doi: 10.1159/000524427. eCollection 2022 May-Aug.
Gastric cancer is strongly associated with atrophic gastritis associated with infection. The eradication of has been reported to improve inflammation of the gastric mucosa, atrophy, and intestinal metaplasia and has also been shown to inhibit the development and growth of gastric cancer. Advanced gastric cancer from -negative mucosa without inflammation, atrophy, or intestinal epithelialization is rarely found. We report on two cases of advanced gastric cancer without endoscopic evidence of gastric mucosal atrophy. One case was in the gastric angle 9 years after eradication and the other case was in the pylorus of an uninfected stomach. Although gastric cancer is strongly associated with atrophic gastritis caused by infection, postoperative histopathological examination of the stomach in both cases showed no inflammation, atrophy, or intestinal metaplasia. Poorly differentiated adenocarcinomas were confirmed at the microscopic level, and both cases were determined to be type 4 using the Borrmann classification. There is a body of evidence showing that infection can cause gastric cancer and is the most prevalent infection-induced cancer in the world. The 2 cases here displayed different carcinogenesis than gastric mucosal atrophy caused by infection. With the spread of eradication treatments and an increasing number of uninfected patients, these case reports can contribute to future strategies for the diagnosis of gastric cancer.
胃癌与幽门螺杆菌感染相关的萎缩性胃炎密切相关。据报道，根除幽门螺杆菌可改善胃黏膜炎症、萎缩和肠化生，还可抑制胃癌的发生和发展。很少发现源自无炎症、萎缩或肠上皮化生的幽门螺杆菌阴性黏膜的进展期胃癌。我们报告两例无胃黏膜萎缩内镜证据的进展期胃癌病例。一例在根除幽门螺杆菌9年后发生于胃角，另一例发生于未感染幽门螺杆菌的胃的幽门部。尽管胃癌与幽门螺杆菌感染引起的萎缩性胃炎密切相关，但两例患者术后胃的组织病理学检查均未显示炎症、萎缩或肠化生。显微镜下证实为低分化腺癌，两例均采用Borrmann分类法判定为4型。有大量证据表明，幽门螺杆菌感染可导致胃癌，是世界上最常见的感染诱发癌症。这里报告的两例病例显示出与幽门螺杆菌感染引起的胃黏膜萎缩不同的致癌机制。随着幽门螺杆菌根除治疗的普及和未感染患者数量的增加，这些病例报告可为未来胃癌诊断策略提供参考。
