胃の巨大細胞性封入体症―とくに潰瘍との関連について

Cytomegalic Inclusion Disease of the Stomach: especially on its relation to gastric ulcer

　巨大細胞性封入体症（cytomegalic inclusion body disease），または唾液腺ウイルス感染症（以下CMIDと略す）は，1904年JesionekとKiolemenoglou¹⁾の報告以来多数の文献があり，乳幼児剖検例の唾液腺には10～12％^2)～4)もあると言われており，種々の内臓に巨大細胞性封入体，cytomegalic inclusion body（以下CMIと略す）がみられるものも，1～2％²⁾³⁾⁵⁾と決して稀ではない．しかし成人例の報告は比較的少なく，それも種々の重篤な疾患の末期に，各種臓器にCMIDが合併した剖検報告が多い．生検例では，1943年Hartz⁶⁾が直腸ポリープにCMIを証明した報告が最初である．著者らは最近臨床的に胃癌を疑われて切除した胃潰瘍例の幽門腺，および十二指腸腺に，広汎なCMIを認め，これが胃潰瘍の成立に何らかの関連を持つと考えられる結果を得たので，この点を中心に報告する．

症例

　患　者：31歳　男　国鉄職員

　家族歴：母方の祖父が胃癌で死亡．

　既往歴：18歳の時，鼻茸の手術，他特記すべきことはない．

　主　訴：吐血，悪心嘔吐，上腹部膨満感．

　現病歴：約1年半前から空腹時に胃部とう痛があった．昭和45年4月5日風邪気味で，売薬を服用，その2日後より悪心嘔吐が出現し，2回にわたりコーヒー残渣様の吐血をみ，某医を訪問し，胃レ線検査を受け，翌15日入院した．17日間の入院中に数回の吐血があり，発症以来約10kgも体重が減少した．胃レ線検査と胃内視鏡検査で胃癌を疑われ，5月2日新潟大学附属病院外科に入院した．

　Cytomegalic inclusion disease has two types : infantile and adult. Each of them can also be divided into the localized variety confined within a certain organ and the visceral variety spread in various organs. Infantile localized type is most commonly seen in the parotic glands and its incidence is high, but adult localized type is very rare. In the literature there have been only 7 reports of it confined within the stomach.

　The patient is a 31 years old male. Clinically he was suspected to harbor advanced carcinoma in the pyloric region. A number of cytomegalic inclusion bodies were seen within the resected stomach. Most striking was their mode of distribution. While not a single body was seen in the fundic glands, they were widely distributed within the pyloric glands and Brunner's glands in the duodenum, numbering from 1.0 to 17.3 per cm on preparations. A Ul-Ⅲ ulcer was also found in the pylorus, and this was considered no accidental complication, but was believed to have arisen out of depressed changes in the course of chronic gastritis provoked by localized type of cytomegalic inclusion disease. The reasons for our conclusions are as follows:

　1. The ulcer was located in a part compatible neither with Oi's theory of mucosal principle―“Gastric ulcer is located closely to the borders between the areas of fundic glands and pyloric glands, originating not in the fundic gland area but in pyloric gland area”― nor does it agree with his theory of muscle principle -“Gastric ulcer occurs in an area encircled both by the bordering circular coat and the innermost oblique coat in the anterior and posterior wall.”

　2. While only slight superficial gastritis was observed on the fundic gland area which was free from inclusion bodies, severe gastritis was seen in the pyloric gland area where widely distributed.

　3. When the entire pyloric gland area was divided into the oral portion and distal one, the former with smaller number of inclusion bodies showed only either depressed gastritis or multiple erosions in an irregular way, while the latter with more numerous bodies presented an ulcer with the depth of Ul-Ⅲ.

　4. No steroid was employed in the medical management of this patient.

　Reference has also been made to the literature of cytomegalic inclusion disease localized within the stomach.