異型上皮を有する隆起性病変の血友病を伴った1例

A CASE OF HEMOPHILIA WITH AN ATYPICAL EPITHELIUM IN A PROTRUDING LESION OF THE STOMACH

Ⅰ．症例

　集団検診で胃病変を指摘され，よく検索してみると，組織学的にも良悪性の境界領域にある隆起性異型上皮病変であり，しかも，患者自身も気づかなかった血友病を合併した症例を経験し，この手術を異常なく行なったのでこれを報告する．

患者：小○忠○　55歳　♂　会社員

主訴：集検で胃病変を指摘され手術希望

　A 55 years old man who had been in good health was found to have a lesion in the stomach. Subsequent X-ray examinations were suggestive of the presence of Ⅱa type early gastric cancer. Concomitantly, he was shown to have hemophilia B, ascertained by laboratory data, including abnormally prolonged coagulation time (30'30”) and decreased PTC.

　Gastrectomy was performed under careful management inclusive of plasma and whole blood transfusion and administration of hemostatic agents. Surgical procedure was uneventful.

　In the resected stomach, well circumscribed protruding lesion, 4.5 cm by 4.0 cm in size, composed of several hemispheric mucosal elevations, was noted on the posterior wall of the corpus. Microangiogram revealed irregular arborization and dilatation of mucosal vessels. Microscopically, a highly hyperplastic atypical epithelium was found in the involved area without any trace of malignancy.

　In recent years, reports of cases of atypical epithelium associated with protruding lesions in the stomach have been increasing in Japan. According to the literature thereupon and on the basis of the experience with five such cases in the authors' clinic, its characteristic features are summarized as follows.

　1. No complaints are usually present.

　2. Achylia gastrica is commom.

　3. Macroscopically it is seen as plateau-like or hemispheric mucosal protrusion, mostly less than 2cm in diameter, sometimes more than 4cm as exemplified in this case.

　4. Microscopically, hyperchromatic epithelium is noted on the surface of the protruding mucosal area, and gastric glands with cystic dilatation are seen in the basal portion of the mucosa.

　As for the diagnostic procedures, gastroscopic biopsy seems to be the method of choice.

　In conclusion, it is mentioned that, although atypical epithelia as a clinical entity have been the subject of much controversy, especially with regard to their origin, neoplastic or otherwise, correct diagnosis and elimination of any other co-existent malignancy is essential before giving an indication for operative surgery or for further observation.