内科的治療で良好な経過を示した胃サルコイドーシスの1例

Gastric Sarcoidosis Showing Favorable Course after Medical Treatment, Report of a Case

　サルコイドーシスは全身的系統疾患であり，現在原因不明である．胃サルコイドーシスは比較的まれで文献的にも三十数例の報告をみるにすぎない．われわれは前胸部痛を主訴とし，胃生検，前斜角筋リンパ節および肝生検によりサルコイドーシスの診断を得，ステロイド治療により良好な経過を得た症例を経験したのでここに報告する．更に1981年までに報告され，収集し得た本邦の34例（本症例を含む）につき文献的考察を加える．

　We report here a case of gastric sarcoid, a rare disease, which had a favorable progress with steroid treatment, with some reference to the literature. The patient, a 30-year-old man, visited our hospital with a chief complaint of pain in the frontal chest after eating. X-ray examination of the stomach showed from the lower body up to mid-body centering on the lesser curvature such change as broad ulcer and irregular rigidity of the contour and hypertrophy of the folds from the body to pylorus. Endoscopic examination also disclosed an irregular broad ulcer on the lesser curvature of the body along with edematous hypertrophy of the adjacent mucosa. Biopsy of the stomach, scalenus node and liver led us to a diagnosis of sarcoidosis. Symptoms subsided about two weeks after steroid treatment, which was discontinued 13 weeks later. Endoscopic examination after treatment showed only an ulcer scar. The patient had a favorable progress since then.

　Reports of gastric sarcoid in our country amount to 33 up to 1981. Summary of them including the present case shows that men and women were equally affected; 17 cases by men and 17 by women. The mean age was 40.5. The symptoms of the upper digestive tract accounted for 85 per cent of chief complaints. By x-ray examination of the stomach, ulcerative lesions were found in two-thirds of the patients, and poor distensibility or rigidity of the gastric wall was seen in 40 per cent. Endoscopic examination also revealed ulcerative lesions in 60 per cent of cases. In 12 patients for whom biopsy was performed a diagnosis of gastric sarcoid was obtained in 67 per cent. The final diagnosis was gastric cancer 40 per cent, gastric ulcer 29 per cent and gastric sarcoid 23 per cent. Laparotomy was performed in 29 patients. The depth of the lesions was within the mucosa in seven patients and in the serosa in 14 patients. Three patients had a favorable progress with steroid therapy.