Kubo Toshiyuki, Adachi Yasushi, Sasaki Yasushi, Adachi Yasuyo, Yoshida Yukinari, Endo Takao, Ishii Yoshifumi, Takahashi Hiroaki, Goto Akira
Division of Gastroenterology, Department of Internal Medicine, Sapporo Shirakaba-dai Hospital, 2-18 Tsukisamu-Higashi, Toyohira-Ku, Sapporo, 062-0052 Japan.
Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-Ku, Sapporo, 060-8543 Japan.
Int Cancer Conf J. 2024 Jun 4;13(4):367-373. doi: 10.1007/s13691-024-00689-z. eCollection 2024 Oct.
Type-A gastritis/autoimmune gastritis (AIG) has gained renewed attention due to declining infection rates and increasing eradication. AIG is associated with pernicious anemia (PA) and is prone to complicate various tumors, such as gastric cancer and neuroendocrine tumors. This report describes a case of AIG with PA in which gastric and esophageal cancers arose simultaneously. An 86-year-old woman had been diagnosed with PA and AIG 9 years earlier. As routine blood tests revealed high levels of carcinoembryonic antigen, she underwent esophagogastroduodenoscopy, which revealed a type 0-IIa lesion in the middle part of the stomach and a type 0-IIa + IIb lesion in the lower esophagus. Endoscopic submucosal dissection was performed on both lesions, since neither distant nor lymph node metastases were identified. Histological examination showed gastric tubular adenocarcinoma and esophageal squamous cell carcinoma. Immunohistology revealed that cells from neither cancer expressed gastrin, gastrin receptor, or p53. Whole-exome sequencing showed 8 gene mutations in the esophageal cancer and 6 mutations in 5 genes in the gastric cancer. The reason for the lack of p53 immunostaining was that was mutated in these cancers, although mutations differed. Thus, mutations may not be detected by immunostaining alone. When treating patients with AIG/PA, clinicians must be aware of the possibility of esophageal cancer coexisting with gastric cancer.
由于感染率下降和根除率上升，A型胃炎/自身免疫性胃炎（AIG）再次受到关注。AIG与恶性贫血（PA）相关，且易并发各种肿瘤，如胃癌和神经内分泌肿瘤。本报告描述了一例AIG合并PA的病例，其中胃癌和食管癌同时发生。一名86岁女性9年前被诊断为PA和AIG。由于常规血液检查显示癌胚抗原水平升高，她接受了食管胃十二指肠镜检查，结果显示胃中部有0-IIa型病变，食管下段有0-IIa + IIb型病变。由于未发现远处转移和淋巴结转移，对这两个病变均进行了内镜下黏膜下剥离术。组织学检查显示胃管状腺癌和食管鳞状细胞癌。免疫组织化学显示，两种癌症的细胞均未表达胃泌素、胃泌素受体或p53。全外显子测序显示食管癌中有8个基因突变，胃癌中有5个基因的6个突变。p53免疫染色缺失的原因是这些癌症中 发生了突变，尽管 突变不同。因此，仅通过免疫染色可能无法检测到 突变。在治疗AIG/PA患者时，临床医生必须意识到食管癌与胃癌共存的可能性。
