submucosal heterotopic gastric gland polypの1例

Submucosal Heterotopic Gastric Gland Polyp, Report of a Case

要旨　患者は48歳の男性．検診で胃の異常と貧血を指摘されて受診した．胃X線検査で体上部に認めた結節状の巨大な粘膜下腫瘤は，内視鏡検査では緊満した脳回状の形態を示し，超音波検査では内部に多発性の囊胞を認めた．摘出された腫瘤（13×7×7cm）は，病理組織学的に，粘膜下組織において増生した腺管組織から成り，これら腺管の周囲には不整な束状の平滑筋層と幽門腺あるいは噴門腺類似の腺組織を伴っていた．またこの病変は，粘膜筋板の欠損部で表面を被覆する固有粘膜層と連続していた．以上から，隆起性増生を示した異所性胃腺組織とみなし，submucosal heterotopic gastric gland polypと診断した．

　A 48-year-old man visited our hospital for further examination of his stomach because he had been found, at a mass screening, to have an abnormality in his stomach and anemia. An upper gastrointestinal x-ray series demonstrated a giant nodular submucosal tumor in the upper gastric body. Endoscopical examination revealed that the head of the tumor had the appearance of brain folds. When ultrasonography was performed, multiple cystic lesions were detected in the tumor and an operation was performed. Histology of the tumor (13×7×7cm) revealed that the tumor was composed of dilated glands which were surrounded by irregular bundles of fibromuscular tissue. Under the dilated glands, there were small glandular tissues like pyloric or cardiac glands. Surface proper mucosal tissue and submucosal glandular tissue were connected at the site of the discontinuous muscularis mucosa. We reported this giant protruded lesion of the heterotopic gastric gland, and we considered this rare lesion to be “a submucosal heterotopic gastric gland polyp”.