慢性膵炎に随伴した限局性胃腫瘤の1例

Localized Gastric Tumor Complicated with Chronic Pancreatitis, Report of a Case

　最近，われわれは膵の高度の炎症が原因となリ二次的に胃腫瘤を形成したと思われる1例を経験した．胃周囲の炎症に随伴して胃内にくびれを有するほどの限局性隆起を来した例は調査しえた内外の文献にも報告がなく，極めてまれな1例と思われ，若干の考察を加えて報告する．

　A 60-year-old man, a long habitual drinker, was admitted to the hospital with chief complaints of chest pain on the left side and hematemesis. The palpebral conjunctiva were anemic, but there was no sign of jaundice. Physical examination of the chest showed no abnormality. There was a scar of previous operation on the upper abdomen, but as a whole the abdomen was flat, nor was there any tenderness or palpable mass. Pain in the chest was regarded as a result caused by anemia. X-ray examination and endoscopy of the stomach revealed a localized protruding tumor with gyri-like surface on the posterior wall of the cardia as well as an ulcerlike lesion on the anterior wall. No malignancy was recognized in the peptic ulcer. The protruding lesion the size of a hen's egg was considered as either submucosal tumor, localized varix or some infiltrative lesion caused by the compression of a pancreatic tumor. But preoperatively there was not enough evidence to arrive at accurate diagnosis. Surgical intervention showed findings of chronic pancreatitis and peripancreatitis. Marked organic adhesion was especially seen on the serosal side at the base of the tumor. In the resected specimen no real tumor was seen previously recognized by both x-ray and endoscopy as a protruding lesion with gyri-like surface. In fact it was a lesion chiefly consisting of non-epithelial fibrous proliferation. Fibrosis was most pronounced on the serosal side of the stomach, extending to the subserosal layer, the muscular coat and reaching to the submucosal layer. Clinical findings, those at operation and pathological findings led us to arrive at the final diagnosis of localized gastric tumor accompanying chronic pancreatitis. The mechanism of development of such a rare tumor and its differential diagnosis is further discussed.