興味ある形態を呈した肥厚性胃炎の1例

Hyperplastic Gastropathy, Report of a Case

要旨　患者は胃幽門前庭部の結節性病変を指摘され入院した33歳の男性である．入院時胃透視にて結節性病変を認め，小彎側胃角から幽門輪を中心に“けば立ち”様所見がみられた．内視鏡検査では，病変は幽門部に限局しており，病変の表面は平滑で，びらん，潰瘍は認めなかった．大きさは不同で，径約1～2cmであった．生検組織診では腺窩上皮の過形成を認めるのみであり，非上皮性腫瘍が強く疑われた．1986年7月8日手術を施行した．新鮮切除標本では，病変の表面は粘液分泌を示しており，幽門前庭部に密に存在していた．割面では粘膜は肥厚していたが，固有胃腺は正常であった．以上により本症例は，1973年Mingが提唱したhyperplastic gastropathyと考えられた．

　A 33-year-old man was admitted to our hospital on June 23, 1986 because of nodular lesions of the gastric antrum. His only complaint was epigastric discomfort with normal physical examination.

　An x-ray examination on admission revealed nodular lesions in the antrum. “Shaggy pattern” was seen mainly along the lesser curvature from the angle to the pyloric ring. On endoscopic examination, the nodular lesions, ranging from 1 to 2 cm in diameter, were localized to the antrum. The surface of these lesions was smooth and lacked erosion or ulceration at all.

　Pathological examination of biopsy specimen showed only hyperplasia of the foveolar cells. We strongly suspected nonepithelial tumor, and operation was done on July 8, 1986. Examination of the fresh resected specimen revealed that the lesions, densely distributed in the antrum, were covered by mucus. Examination of the cut specimen showed hypertrophic mucosa with normal proprial glands.

　These findings confirmed the diagnosis of hyperplastic gastropathy, which was first proposed by Ming in 1973.

　As diseases to be differentiated, Ménétrier's disease, Cronkheit-Canada syndrome, Peutz-Jeghers syndrome and atrophic hyperplastic gastritis were considered.