生検組織固定標本よりTreponema pallidumが証明された胃梅毒の1例

Gastric Syphilis Confirmed by Biopsy, Report of a Case

要旨　患者は26歳，男性．内視鏡検査にて幽門前庭部に周囲に白色調の隆起を有する不整形の粘膜病変の多発を認めた．2週間後，病変は進展しており一見Borrmann 4型胃癌様所見を呈した．胃梅毒を疑い駆梅療法を開始したところ，1か月後には内視鏡所見の著明な改善を認めた．後日，酵素抗体ABC法にて生検組織問定標本の切片よりTreponema pallidumを証明し胃梅毒の確定診断を得た．近年早期梅毒患者が増加しているが，多彩な胃粘膜病変を認めた場合には，臨床医は胃梅毒の可能性のあることを病理医に報告することが大切であり，病理医は積極的に特殊染色を行いTreponema pallidumの検出に努めなければならないと思われた．

　A 26-year-old man visited our hospital because of epigastralgia. Endoscopic examination revealed an irregular ulceration at the gastric angulus and multiple erosions in the antrum. Histological examination of the biopsy specimen showed severe infiltration of plasma cells. In spite of the administration of H₂-receptor antagonist, his symptoms did not improve with rather worsening ulcer lesions. Serological test for syphilis turned out to be strongly positive. The patient confessed having had a chance of syphilitic infection about 4 months before. Thus, it was quite likely at this moment that the gastric lesions were due to syphilis. Antiluetic therapy was started resulting in the marked improvement of subjective symptoms and endoscopic findings. Treponema pallidum was later demonstrated in formalinfixed gastric biopsy specimens by Warthin-Starry silver impregnantation and by immuno-pemxidase technique establishing the diagnosis of gastric syphilis.