胃底腺から成る胃粘膜下heterotopiaの1例

Suhmucosal Heterotopia of the Stomach Composed of Fundic Glands, Report of a Case

要旨　心疾患，甲状腺機能亢進症を治療中の71歳の男子に，たまたま健康診断的に行った上部消化管X線検査により胃体下部大彎の隆起性病変（20×15mm）を発見した．引き続き行った胃内視鏡検査所見も総合し，癌も否定はできないが，粘膜下の悪性腫瘍を強く疑い胃切除術を行った．切除胃の肉眼所見では粘膜下に限局した灰白色の腫瘍様病変がみられ，組織学的には胃底腺と腺化上皮がheterotopicに増生した珍しい病変であった．

　A 71 year-old man underwent a medical check-up. Upper gastrointestinal x-ray series demonstrated a filling defect at the greater curvature of the body of the stomach. Endoscopic study revealed an elevated lesion with bridging folds. The tip of the lesion was ulcerated. Gastric biopsy was proved to be nonmalignant.

　However, partial gastrectomy was performed, because there seemed a probable chance that the lesion might cuntain a submucosal malignant tumor.

　Gross finding of the resected specimen showed an elevated hemispherical lesion. 1.5×1.3 cm in size. The lesion was mainly located in the submucosal region of the stomach, well-defined and separated from the surrounding normal tissue. The tip of the lesion was slightly depressed, and erosive.

　Histologically, it was proved that the fundic glands and crypt epithelium increased locally in the submucosal layer keeping its organoid pattern. This is a lesion infrequently seen although a few literature concerning resembled lesion was noted.