胃glomus腫瘍の1例

Glomus Tumor of the Stomach, Report of a Case

要旨　患者は67歳，女性．心窩部痛，黒色便を主訴に1989年11月本院を受診．2年前の胃集検で胃腫瘤を指摘されていた．胃X線検査ならびに胃内視鏡検査では，胃角小彎に表面に陥凹を伴った粘膜下腫瘍を認めた．この腫瘤は筋腫などに比して非常に柔らかい感じのする腫瘤であった．また，電子内視鏡でやや暗青色様に感じられた．超音波内視鏡を施行し，粘膜下に高，低エコーの混在した腫瘤を認めた．胃生検で小型の細胞が多数の血管腔周囲に増殖する所見が得られglomus腫瘍と診断された．腫瘍は電子顕微鏡で胞体内に微細なフィラメントを認め，免疫組織化学的検索でクレアチニンリン酸キナーゼ抗体陽性を示し筋原性であることが示唆された．

　A 67-year-old female was admitted with chlef complaints of epigastric pain and tarry stools.

　X-ray examination revealed a smooth and flat hemispheric mass with tiny depression in the lesser curvature of the gastric angulus. The tumor appeared rather soft when compressed. A submucosal tumor with surface ulceration was found endoscopically. Endoscopic ultrasonography showed the tumor in the submucosal layer as a hypoechoic and heterogenous mass. Furthermore, electronic endoscopy revealed the surface flat and bluish. Examination of the resected stomach showed that this bluish mass, measuring 3×3 cm, was situated in the lesser curvature of the gastric angulus. The mass was histologically confirmed as a glomus tumor by biopsy. This tumor developed expansively in the submucosa and invaded into the serosa exhibiting an acinous pattern. Immunohistochemical analysis by electron microscopy revealed tumor traits originating from the smooth muscle tissue and tumor cells made up of creatinin phosphokinase.

　Preoperative diagnosis of glomus tumor may be possible based on radiologic and endoscopic findings and by taking into consideration histological findings of biopsy specimen taken from the deeper layer of the stomach.