原発性胃アミロイドーシスの1例

Primary Amyloidosis of the Stomach, Report of a Case

　アミロイドーシスは最近，わが国でも注目され報告例が増えている疾患である．その主たる沈着臓器は，腎，肝，心，脾であるが，胃腸管へのアミロイド沈着もよく認められる．その症状として食思不振，下痢，血便があり，また吐血，下血を来した症例にはX線透視，内視鏡検査および生検が行われているが，確診されたのは，剖検例がほとんどで，胃切除が行われたという報告は少ない．

　われわれは最近，大量の吐下血を来し，X線透視および内視鏡検査で悪性リンパ腫を疑い，胃全摘の結果，原発性胃アミロイドーシスであった症例を経験したのでここに報告する．

　A 60-year-old woman was admitted to our hospital with upper gastrointestinal bleeding on Jan. 9, 1978. She had episodes of complaints of anorexia and nausea since Sept. '77 without medications.

　Four days before admission, she complained of dull epigastric pain and had tarry stool.

　On the basis of easily bleeding mucosa, an ulcerative lesion at the greater curvature of the antrum and giant folds seen endoscopically and radiologically, the case was interpreted as malignant lymphoma or advanced cancer (Borrmann 3). However, biopsy specimens were histologically negative for malignancy.

　A total gastrectomy was performed because of persisting gastrointestinal bleeding. Macroscopically, the mucosa of the resected stomach was diffusely edematous and swollen with submucosal bleeding, but no dominant ulceration or tumor was seen. Microscopically, homogenous acidophilic depositions were seen among the muscle fibers of the muscularis mucosa and every surrounding submucosal vessels. This material was positive for congo red and crystal violett stain, indicating the presence of the amyloid infiltration.

　Postoperatively, workup for amyloidosis was done. Rectal biopsies were negative for amyloid deposition. Serum immunoelectrophoresis revealed a normal pattern and other laboratory data were within normal range.

　About four months later, she complained of severe abdominal pain and unfortunately died of asphyxiation by the aspiration of vomitus.

　An autopsy was performed. Acute panperitonitis resulting from the perforation of strangulated ileum was recognized. Microscopic examination revealed that amyloid deposition was only seen in the left lung, and not in other organs (kidney, liver, heart, bone, muscle,G-I tract, etc.).