胃サルコイドーシスの1例

Sarcoidosis of the Stomach, Report of a Case

要旨　患者は43歳，女性．空腹時心窩部痛を主訴とし来院．上部消化管内視鏡検査にて胃角上部小彎に境界が不鮮明で白苔を有する浅い潰瘍性病変を認めた．胃X線検査でも胃角上部に敷石模様を有する陥凹性病変と小彎の壁の硬化像が認められⅡc型早期胃癌かMALTリンパ腫が疑われた．潰瘍周辺からの生検では，粘膜固有層内に乾酪壊死を伴わない類上皮細胞肉芽腫が多数認められ，サルコイドーシスと診断した．治療はPPIの8週間投与に加え，H. Pylori除菌療法を施行した．潰瘍は治癒し病理組織学的に肉芽腫は縮小した．

　A 43-year-old female was admitted with the chief complaint of epigastric pain. An endoscopic examination of the stomach showed a shallow ulcerative lesion in the lesser curvature above the gastric angle, which had an unclear border and was covered with a white coating. Upper gastrointestinal series also showed an ulcerative lesion presenting cobblestone-like appearance and wall stiffness. These findings led to the suspicion of either Ⅱc type early gastric cancer or MALT lymphoma. Since the biopsy specimen from around the ulcerative lesion revealed a lot of epithelioid cell granulomas without caseous necrosis in the lamina propria mucosa, the lesion was diagnosed as sarcoidosis. Eight weeks of proton pump inhibitor treatment followed by H. pylori eradication treatment healed the ulcerative lesion and a histopathological examination found a decreased number of granulomas.