広範な萎縮，びらん，出血所見を呈し，診断に苦慮した自己免疫性汎胃炎（autoimmune pangastritis）の1例

Autoimmune Pangastritis, Report of a Case: Is this a New Disease ?

要旨　患者は64歳，女性．体重減少と胃部不快感で近医を受診し，胃内視鏡検査で異常を指摘され精査目的に当院紹介となった．胃内視鏡検査では胃全体に粘膜萎縮が著明でひだがほとんど消失し，不整形びらん，小潰瘍が胃体部を中心に存在した．また，内視鏡検査時の送気により，容易に粘膜のひびわれと出血を来した．内視鏡所見では，表層拡大型の悪性リンパ腫やスキルス胃癌が否定できず，胃生検や診断的EMRを繰り返し施行したが，悪性所見を認めなかった，その後，約半年間経過を観察したが，心窩部痛は悪化し，X線像も進行性の胃硬化像を認めたため，十分なインフォームドコンセントのもとに胃全摘を行った．組織学的には，胃全体に著明な萎縮と出血，びらんが存在したが，悪性所見は認められなかった．残存した上皮周囲のリンパ球の免疫染色ではCD8陽性細胞の著増とCD4陽性細胞の著減を認め，HLA-DRも著明に発現していた．以上より発症原因として自己免疫の関与が考えられた．

　We report a very rare case of autoimmune pangastritis with severe atrophy, erosion, and hemorrhage. A 64-year-old woman was referred to Nagano Red Cross Hospital in January, 2001 for further examination and treatment of a gastric abnormality. She was complaining of epigastralgia and body weight loss. Endoscopic examination revealed severe atrophy, erosion, and hemorrhage in the body and the antrum of the stomach. Barium meal examination showed progressive rigidity of the whole stomach. Histological findings of many conventional biopsy specimens and a jumbo biopsy specimen using endoscopic mucosal resection revealed no malignancy such as cancer or lymphoma, and no amyloid deposit, but only non specific inflammation. She was followed up for 6 months by conservative therapy using mucosal protective agents and histamine type 2 receptor antagonists, but her condition became worse. The possibility of diffuse, infiltrating type of gastric cancer could not been denied, so total gastrectomy was performed in September, 2001. Histological findings of the resected specimen showed neither gastric cancer nor gastric lymphoma. Analysis of the lymphocyte subset distribution showed that the lamina propria of the stomach contained more CD8 ＋ than CD4 ＋ lymphocytes, further, focal HLA-DR reactivity was shown in the stomach. Since it is clear that this specfic gastritis has association with autoimmune gastritis, we named this case autoimmune pangastritis. This is the first report in medical literature regarding autoimmune pangastritis.