限局性肥大性胃炎の1例

Localized Hypertrophic Gastritis: a case report

　巨大皺襞症に関しては，Ménétrier以来，Butz，Reese，Schindler，その他多くの報告があるが，未だその臨床的，病理組織学的にその概念が確立されたとは言えない．さらに今日においては，広義な意味での巨大皺襞症と，狭義のそれの一つであるMénétrier氏病とが混同されている感すらうける．

　今回われわれは，レントゲン，内視鏡的に巨大皺襞を示し，臨床的病理組織学的に興味ある1例を経験したので，多少の文献的考察を加えて報告する．

　The patient, a 47-year-old man, had a sudden bout of pain in the lower abdomen followed by watery diarrhoea on Dec. 14, 1969. On Jan. 6 of the following year he was examined by a gastroenterologist with a series of examinations such as x-ray study of the stomach, gastrocamera, barium enema study of the colon and colonoscope. Despite of ambulatory treatment his symptoms did not abate, and he came to our department.

　Except for slight tenderness around the navel and in the lower left quadrant, physical examination was non-contributory. Plasma protein level was 7.6 g/dl with normal acidity in the gastric juice. Other laboratory examinations including the liver function tests were all normal. Re-examination with gastrocamera on March 10 revealed tortuous mucosal folds localized in the greater curvature side of the angle region. Biopsy specimens taken from them disclosed Group I, so that he was subjected to gastric resection under a diagnosis of giant folds of the stomach. Resected stomach showed an area, measuring 5.0×5.5 cm, of convolutional, tortuous folds in the greater curvature side 5 cm oral from the pylorus. Histologically, the tumor was found to have originated in the side of fundic gland area located in the border zone. The mucosa was highly hypertrophic owing to remarkable hyperplasia of the proper gastric gland, with accesory cells markedly increased in number. Slight inflammatory chagnes were also observed in the mucosal epithelium, with other layers remaining almost intact.

　The case here described is of a rare occurrence, corresponding to chronic hypertrophic glandular gastritis as designated by Schindler, because not only the gastric juice and plasma protein level were normal, but also histologically the findings were different from those reported by Ménétrier, Palumbo and others. The mucosal epithelium was slightly atrophic, with striking hyperplasia of proper gastric gland, in particular associated with marked increase in number of accessory cells.