一例Ménétrier病缓解后15年监测期间发现早期胃癌并成功行内镜黏膜下剥离术治疗的病例报告

摘要(中文译文)

一名70多岁女性根据低白蛋白血症及从胃体延伸至胃底的巨大胃皱襞被诊断为Ménétrier病（MD）。血清抗抗体检测和尿素呼气试验结果均为阴性。经类固醇治疗后获得缓解，并使用质子泵抑制剂维持无复发状态。患者持续每年接受食管胃十二指肠镜检查（EGD）以监测胃癌。MD诊断15年后，于胃体上部后壁检出0-I型高分化管状腺癌。EGD、计算机断层扫描和内镜超声均未发现提示MD复发的征象，该病灶被认为局限于黏膜内。内镜黏膜下剥离术实现了治愈性整块切除。组织病理学未显示活动性MD的证据。患者始终保持MD无复发及胃癌无复发状态。MD以巨大胃皱襞和蛋白丢失性胃肠病为特征，被认为是胃癌的危险因素。然而，像本例这样在药物治疗诱导临床缓解后的长期随访中检出早期胃癌并接受内镜治疗的报道较为罕见。本病例强调了即使MD长期临床缓解后，仍需持续进行内镜监测以发现胃癌发生的重要性。

Abstract

Ménétrier disease (MD) was diagnosed based on hypoalbuminemia and giant gastric folds extending from the body to the fundus in a woman in her 70s. A serum anti- antibody test and urea breath test yielded negative results. Remission was achieved with steroid therapy, and she was relapse-free with the use of a proton pump inhibitor. Annual esophagogastroduodenoscopy (EGD) was continued for gastric cancer surveillance. Fifteen years after the diagnosis of MD, a type 0-I well-differentiated tubular adenocarcinoma was detected on the posterior wall of the upper gastric body. EGD, computed tomography, and endoscopic ultrasonography revealed no findings suggestive of MD recurrence, and the lesion was considered intramucosal. Endoscopic submucosal dissection resulted in curative en bloc resection. Histopathology revealed no evidence of active MD. The patient remained free of MD relapse and gastric cancer recurrence. MD is characterized by giant gastric folds and protein-losing gastroenteropathy, and it is considered a risk factor for gastric cancer. However, reports of gastric cancer diagnosed at an early stage and treated endoscopically during long-term follow-up after clinical remission induced by medical therapy, as in the present case, are rare. This case highlights the importance of continued endoscopic surveillance for gastric carcinogenesis even after long-term clinical remission of MD.

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