巨大な胃inflammatory fibroid polypの1例

Huge Inflammatory Fibroid Polyp of the Stomach, Report of a Case

要旨　患者は61歳，男性．高度貧血によるめまいを主訴に来院．心窩部に巨大腫瘤を触れ，精査の結果，胃inflammatory fibroid polypと診断した．腫瘤の大きさは7×5.8×4cmで，全体としては粘膜下腫瘍の形をとりながら，腫瘤の上半分が粘膜欠損を起こしドーム様となっていた．また陥凹面は平滑で，底部は透けて見える特異な形状を示した．長径5cm以上の巨大な本病変は文献上15例にみられ，粘膜下腫瘍，有茎性ポリープ，無茎性上皮性腫瘍などの形をとり，上皮性と非上皮性両者の形態を示していた．自験例にみられる陰茎亀頭様外観は，既に7例の報告があり，他の疾患にはみられない特異な形状であるところから，X線および内視鏡診断が可能と思われた．

　A 61 year-old male was admitted because of dizziness due to severe anemia. Upper gastrointestinal series and endoscopy disclosed a submucosal tumor with a large ulceration on the lesser curvature of the gastric antrum. Laparotomy was performed under the diagnosis of leiomyosarcoma. The resected specimen revealed a unique lesion of protrusion, measuring 7×5.8×4 cm, with the upper half being ulcerated. Histologically, the lesion mainly occupied the submucosa and was composed of fibroblastic overgrowth with abundant capillaries, plasma cells, lymphocytes and eosinophils.

　Fifteen cases of inflammatory fibroid polyp larger than 5 cm in diameter were reviewed. The lesions could present with a variety of appearances such as pedunculated polyps, sessile polyps and submucosal tumors. This fact indicates the potentiality of the lesion to present with either epithelial tumor or non-epithelial tumor.

　Seven cases in the literature as well as our case had glans penis-like appearance, which was so unique that radiographic or endoscopic diagnosis might have been possible.