胃サルコイドージスの1例

A Case Report of Sarcoidosis of the Stomach

　胃生検で胃結核，あるいはサルコイドージスを疑い，手術でサルコイドージスと診断した1例を報告する．

症例

　患　者：塗○美○　42歳の男子

　主　訴：胃部重圧感

　既往歴：家族歴：特記すべきものはない．

　経過：数カ月前から主訴あり．昭和50年2月25目人間ドック（AMHT，自動化検診システム）を受診した．胃X線検査でⅡc様病変を指摘され精査をうけ入院し，4月25日胃切除術をうけた．

　入院時検査所見：顔貌正常，皮膚・眼瞼結膜に貧血，黄疸なし．表在リンパ節腫脹なし．胸部打聴診異常なし．腹部平坦，圧痛抵抗なし．腫瘤触れず．肝，脾を触れない．その他サルコイドージス，または，結核を思わせる所見なし．

　検査成績：尿検査，蛋白（－），糖（2＋）．便潜血（－）．末梢血，赤血球464×10⁴，白血球5,600，Hb15.8g/dl．血液生化学異常なし．梅毒反応陰性．血糖負荷試験（100g T. G. 負荷），前82mg/dl，1時間値172mg/dl．ツ反応陰性．胸部X線検査異常なし．胃液検査BAO 0.008mEq/h，MAO 0.169mEq/h（ガストリン1μg 筋注）．胃液培養結核菌陰性．なおKveim反応は施行しなかった．

　A man 42 years of age with a complaint of epigastric opperession feeling underwent through examinations of the stomach in our hospital.

　There were no abnormal findings in the chest X-ray films and no symptoms suggesting tuberculosis or sarcoidosis. M-R was negative, although KveimReaction was not performed.

　Through the upper G-Ⅰ tract X-ray and endoscopic examinations, multiple gastric ulcers and scars were found in the prepyloric region and its vicinity.

　Langhan's giant cells and epitheloid cells were detected massively by biopsy. From this fact, gastric tuberculosis or sarcoidosis was suspected.

　With the macroscopic observation, many ulcers and scars without serious influences to the adjacent mucous membrane were found on the resected part of stomach (anal half of the stomach and the prepyloric region).

　Microscopically, there were many knots of Langhans' giant cells and epitheloid cells in the mucous layer, submucosal layer and the regional lymph nodes, while the Gaseous degeneration could not be found.

　This case was finally diagnosed as gastric sarcoidosis and is perhaps its 17th report in Japan.