術前に早期胃癌と診断した<i>H. pylori</i>陰性進行胃癌の1例

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  • A case of <i>Helicobacter pylori</i>-negative advanced gastric cancer preoperatively diagnosed as early gastric cancer

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A 52-year-old woman was referred to the hospital with the chief complaint of dysphagia. Upper gastrointestinal (GI) endoscopy showed reflux esophagitis ; fundic gland polyps and a shallow discolored depressed lesion measuring approximately 10 mm in diameter were observed in the anterior wall of the gastric lower body, with no evidence of atrophic changes. Histopathological examination of biopsy specimens showed evidence of signet ring cell carcinoma in the depressed lesion and a negative result for Helicobactor pylori (HP) on Giemsa staining. The patient had no history of HP eradication therapy. Serology for HP IgG antibody was negative and the result of testing by the pepsinogen method was negative. The carcinoma risk was classified as group A according to the ABC classification. Laparoscopic gastrectomy was performed under the tentative diagnosis of early gastric cancer without metastasis, the latter determined by CT imaging. Histopathological examination of the resected specimen revealed signet ring cell carcinoma in the mucosal layer, with invasion of mainly por2 cancer from the submucosal layer to the proper muscular layer, and abundant connective tissue of the scirrhous type. The background mucosa showed no neutrophil infiltration, or any evidence of atrophy. Based on the findings, we diagnosed the patient as a case of non-HP-infected gastric cancer. In the future, a higher incidence of HP-negative gastric cancer may be found among patients classified into Group A of the ABC risk classification. Upper GI endoscopy should be performed bearing in mind the possibility of HP-negative gastric cancer in cases with GI symptoms, regardless of the results of the ABC classification for gastric cancer screening.

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