胃結核の1例

A Case of Gastric Tuberculosis

　胃結核はきわめて稀な疾患で，最近の胃透視，内視鏡の進歩にもかかわらず確実な診断をつけることは困難とされている．また，その低い発生頻度，感染経路，悪性腫瘍との合併など様々な疑問もいまだ未解決のまま残されている．

　最近，われわれは難治性潰瘍の疑診のもとに手術を行い，術後の病理組織学的検討により胃結核と診断した1例を経験したので，若干の考察を加えて報告する．

　A 19-year-old girl had been complaining of epigastric pain and nausea for six months.

　Physical examination and laboratory findings showed no significant finding except a positive tuberculin test. X-ray examination revealed a shallow filling defect with marginal elevation and converging folds in the lesser curvature of the stomach.

　Endoscopic examination showed slight depression with white coating and marginal protrusion of the anterior wall. Malignant cell was negative in several gastric biopsy materials. Gross findings of resected stomach showed a shallow ulcer, measuring 5.2×2.4 cm, spreading from the gastric antrum to body with slight protrusion of the anterior wall.

　Microscopically, many tuberculous nodules with Langhans' giant cells were seen in the base of ulcer, submucosal layer, subserosal space and also in the regional lymph nodes. There were caseous necrosis in some of them. Furthermore, tuberculous nodes were seen in the walls of vessels of the submucosal layer. In the mucosa around the tuberculous, there were too many lymphfollicles for her age. According to these findings, gastric tuberculosis might be partly concerned with the constitution of many lymph follicles in the gastric mucosa.