スキルス胃癌と鑑別を要する非腫瘍性疾患―自己免疫性汎胃炎

Differential Diagnosis Between Autoimmune Pangastritis and Scirrhous Carcinoma

要旨　76歳，女性．重度の食欲低下，体重減少を主訴に来院した．内視鏡検査で胃全体にびまん性の萎縮とびらん性変化を認め，粘膜ひだは消失し壁は伸展不良であった．生検や診断的EMRを繰り返し行ったが，炎症性変化のみで悪性所見やそのほかの特異的所見を認めなかった．自己免疫機序の関与を考えステロイド剤の投与を試みたが，体重減少が続き経静脈栄養を要したため，初診より約1年後に胃全摘を行い軽快した．本例は2002年に藤沢らが提唱した自己免疫性汎胃炎と同一の疾患と考えられた．スキルス胃癌と鑑別すべき疾患にこのような特異な胃炎が存在することが広く認識され，症例集積から病態解明につながることが望まれる．

　A 76-year-old female came to our hospital presenting severe anorexia and weight loss. Endoscopic examination showed her gastric mucosa was atrophic and erosive in all areas. The mucosal fold was diminished and the gastric wall did not stretch. While those results suggested the diagnosis of scirrhous carcinoma or malignant lymphoma, pathological findings of biopsy and EMR specimens revealed no evidence of malignancy. Only severe inflammation mainly in the lamina propria was observed. We speculated her autoimmune mechanism had caused this disorder and tried corticosteroid therapy. However, her body weight continued to decrease. She needed parenteral nutrition. One year after the first visit, total gastrectomy was carried out and she regained appetite. This case was nearly identical with autoimmune pangastritis, a new disease entity proposed by Fujisawa in 2002. Autoimmune pangastritis should be widely recognized for its mimicking of scirrhous carcinoma in clinical presentation. The pathogenesis of this rare disease can’t be clarified until many similar cases are accumulated and analyzed.