Ａ型胃炎に高ガストリン血症を伴う多発性胃カルチノイドの１例

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  • A CASE OF MULTIPLE GASTRIC CARCINOIDS ASSOCIATED WITH TYPE A GASTRITIS

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We report a case of multiple gastric carcinoids associated with type A gastritis and hypergas-trinemia. Multiple tumors, measuring 5 to 10mm, were observed on the upper and middle stomach in a background of atrophic mucosa. These tumors were histologically diagnosed as gastric carcinoids based on total biopsy samples obtained by endoscopic mucosal resection. Our patient showed gastric parietal cell antibody positive, achorhydria and secondary hypergastrinemia. These findings showed that he was diagnosed as multiple gastric carcinoids associated with type A gastritis. We treated the patient by distal partial gastrectomy in order to downregulate serum gastrin, which can stimulate enterochromaffin-like cells and induce endocrine cell micronests and carcinoid tumors. Therapeutic effects of the operation were that 12 hours later normogastrinemia was acquired, 6 months later the tumors remaining on the remnant stomach had disappeared, and for 3 years no relapsed tumors were found clinically. We speculate that not major surgery such as total gastrectomy but minimally invasive surgery such as distal partial gastrectomy may have enough therapeutic effects against multiple gastric carcinoids associated with type A gastritis.

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