スキルス胃癌と鑑別を要する非腫瘍性疾患―巨大皺襞性胃炎

Enlarged Fold Gastritis Requiring its Differential Diagnosis from Scirrhous Carcinoma, Report of a Case

要旨　患者は39歳，女性．10年前から鉄欠乏性貧血にて加療中であった．2年前より心窩部痛，背部痛を時々認めるようになり，近医を受診したところ，上部消化管内視鏡検査にて異常を指摘され，精査目的で当科を受診となった．上部消化管内視鏡検査では胃体上部から胃角部まで皺襞の腫大，内腔狭窄が認められた．腹部CT検査では胃壁の肥厚を認めたが，X線造影検査と超音波内視鏡検査では胃壁の層構造は保たれていた．^99mTc標識アルブミンを用いたシンチグラフィーでは消化管への蛋白露出は認められなかった．診断目的で内視鏡的胃粘膜切除術を施行し，HP（Helicobacter pylori）感染を合併した巨大皺襞性胃炎と診断された．除菌治療のみで2年間経過するが，経過良好である．

　A 39-year-woman　was admitted to our hospital with epigastralgia and back pain that had extended over 2 years. She was diagnosed as having iron deficiency anemia and now takes iron medication. On gastroscopy, enlarged fold was detected from the upper corpus to the angulus in the stomach. Contrast-enhanced CT and endoscopic ultrasoundscopy showed thickened gastric mucosa. Scintigraphy with ^99mTc-labeled human serum albumin demonstrated radioactivity in the gastrointestinal tract, but the site of the leakage was unclear. For diagnosis endoscopical mucosal resection was performed. Tha patient was diagnosed as having enlarged fold gastritis with Helicobacter pylori infection. 2 years have since passed and she continues to show good progress.