@article{oai:kanazawa-u.repo.nii.ac.jp:00013798,
 author = {中沼, 伸一 and 木南, 伸一 and 尾山, 勝信 and 舟木, 洋 and 藤田, 秀人 and 二宮, 致 and 伏田, 幸夫 and 藤村, 隆 and 萱原, 正都 and 太田, 哲生},
 issue = {9},
 journal = {日本消化器外科学会雑誌},
 month = {Sep},
 note = {症例は58歳の女性で,多発性骨髄腫の化学療法中にCTにて胃体上部の壁肥厚と壁内に多数の嚢胞性病変を指摘された.胃透視検査では体上部から穹窿部に境界不明瞭な壁の硬化を認め,胃内視鏡検査所見は胃体上部後壁を中心とした境界不明瞭な丈の低い結節状隆起を呈していた.組織診は高分化型の腺癌であった.多発性胃粘膜下嚢腫を伴ったBorrmann IV型の進行胃癌と診断し手術を施行した.癌は体上部から穹窿部全体に浸潤し,漿膜露出と腹膜播種も認めた.病理組織学的検査所見は明瞭な腺腔形成を示す高分化型の腺癌で繊維化を伴いびまん浸潤していた.免疫染色検査ではMUC2陰性,MUC5AC・MUC6陽性で胃型であった.高分化型のBorrmann IV型胃癌はまれである.本症例では拡張した癌腺管と,境界不明瞭で丈の低い結節状隆起を示した内視鏡像が特異であり,前者は高分化型Borrmann IV型癌に,後者は胃型の分化型癌に関係した性質と考えられた. A 58-year-old woman admitted for multiple myeloma and treated with chemotherapy was found in Abdominal computed tomography (CT) to have showed wall thickening in the upper gastric body, together with multiple cystic lesions at the same site. Barium enema studies showed wall hardening with unclear margins in the upper gastric body and fundus. Endoscopy showed a low protruding nodular lesion with unclear margins on the posterior wall of the upper gastric body. Endoscopic biopsy indicated well-differentiated adenocarcinoma, yielding A diagnosis of Borrmann type 4 advanced gastric cancer with diffuse heterotopic multiple cysts. The tumor was found to have spread from the upper gastric body to the fundus, with serosal penetration and peritoneal dissemination. The Pathological diagnosis was well-differentiated adenocarcinoma invading all layers diffusely forming large glandular cavities and scirrhous changes. Immunohistochemical staining showed tumor cells to be positive for MUC5AC and slightly positive for MUC6 but negative for MUC2. Based on these findings, the definitive diagnosis was gastric phenotype. Borrmann type 4 advanced gastric cancer consisting of well-differentiated adenocarcinoma alone is rare. Our case suggested two characteristic features: large carcinomatous glandular cavities such as gastric cysts related to well-differentiated adenocarcinoma of Borrmann type 4 advanced gastric cancer, and an endoscopic picture of a low protruding nodular lesion with unclear margins related to differentiated carcinoma with a gastric phenotype.},
 pages = {1472--1477},
 title = {高分化型のBorrmann IV型胃癌の1例},
 volume = {42},
 year = {2009}
}