Case of early-stage gastric cancer identified in the gastric mucosa with lanthanum phosphate deposition
Case of early-stage gastric cancer identified in the gastric mucosa with lanthanum phosphate deposition
复制标题
DOI：
10.1055/a-0918-5804
复制
发表时间：
2019-07-01
影响因子：
2.6
通讯作者：
Terai, Shuji
中科院分区：
文献类型：
--
作者：
Takatsuna, Masafumi;Takeuchi, Manabu;Terai, Shuji
背景和研究目的一位78岁男性幽门螺杆菌感染者因慢性肾功能衰竭接受血液透析并接受碳酸镧制剂治疗3年。内窥镜检查显示整个胃内有细白色颗粒状变色，胃角小弯有中度红色凹陷，周围区域有白色颗粒状变色。使用窄带成像的放大图像显示凹陷部分具有不规则的血管和小凹结构。我们确诊为黏膜内胃癌，并施行内视镜黏膜下剥离术。组织学检查发现一个分化良好的腺癌，仅限于粘膜的凹陷区。此外，使用电子探针微量分析仪装备的电子显微镜，我们发现，镧沉积的程度是低于在肿瘤区域比在非肿瘤区域。因此，目前的情况下，可以帮助了解镧沉积和早期胃癌之间的关系。由于胃癌可发生在含镧沉积物的粘膜中，因此在了解此类病例中早期胃癌的特征后，应谨慎使用食管胃镜。
Background and study aims A 78-year-old man with Helicobacter pylori infection had been undergoing hemodialysis for chronic renal failure and receiving lanthanum carbonate preparations for 3 years. Endoscopy revealed fine white granular discoloration throughout the stomach, a moderately reddish depression on the lesser curvature of the gastric angle, and white granular discoloration in the surrounding area. A magnified image using narrow-band imaging showed that the depressed part had irregular vascular and pit structures. We established a diagnosis of intramucosal gastric cancer and performed endoscopic submucosal dissection. Histopathological examination revealed a well-differentiated adenocarcinoma that was confined to the mucosa of the depressed area. Moreover, using an electron probe microanalyzer-equipped electron microscope, we found that the degree of lanthanum deposition was lower in the tumor region than in the non-tumor region. Thus, the current case can help in understanding the relationship between lanthanum deposition and early-stage gastric cancer. Because gastric cancers can occur in lanthanum deposit-containing mucosa, esophagogastroduodenoscopy should be used carefully after understanding the characteristics of early- stage gastric cancer in such cases.