興味あるX線像を呈した迷入膵の1例

ONE CASE OF THE ABERRANT PANCREAS WHICH SHOWED INTERESTING X-RAY IMAGE.

Ⅰ．はじめに

　近年，胃X線検査，内視鏡検査，細胞診等の検査法の進歩は著しく，早期胃癌をはじめとする各種胃疾患の鑑別診断は一段とその精度を増し，診断能はとみに向上している．胃腫瘍の診断に際し，しばしば問題となる胃粘膜下腫瘍についてはX線診断或いは内視鏡診断に関する諸家の報告も多い．我々は最近粘膜皺襞の走行異常と著明な筋線維の増殖を伴った興味ある迷入膵の症例を経験したので報告する．

　The patient was 47 years-old female. She had no particular history. She had had right hypogastric pain, nausea and vomiting on 15th August A '66. doctor who did the x-ray examination on her recommended her to visit us for the gastrocamera examination. No pathological finding was noticed by the general examination. By x-ray examination, a filling defect with obscure margin was disclosed on the greater curvature of the antrum. By various x-ray photographs, a moustachelike barium fleck seemed to be projected outside the stomach shadow. Gastric folds seemed to run avoiding this tumor. No breaking down or gathering of gastric folds, or other pathological findings were demonstrated. The streching of the gastric wall and peristalsis were normal. The diagnosis of a benign submucous tumor was made. This tumor was considered as aberrant pancreas with a duct. By GTF examination, an elevated change on the greater curvature of the antrum was noticed. The shape of tumor looked like the reversed letter “の”. No change of the color of mucous membrane, no bleeding and no edema were noticed. No bridging fold was observed. The diagnosis was the same as that made by the x-ray examination. Operation was clone on 4th October'66. On the operated stomach, an oval and slight elevation 2.2×1,5cm in size was noticed on the greater curvature of the anterior wall 1.8 cm apart from the pyloric ring. At the greater curvature side of this elevation, another snail-like elevation 1.2 cm in diameter was also noticed.

　No difference was noticed between the mucous membrane of the tumor and normal mucous membrane. Histologically, the inversione of the mucous membrane was noticed in the centre of the elevation. This inverted membrane reached the muscle layer. But no abnormal findings were observed in gland tissue. The inverted membrane formed a tunnel and in the submucous layer around the tunnel, the production of unstriated muscle was found. At the wall of the tunnel, the gland resembling the Brunner's gland was noticed. Two aberrant pancreas tissues with an atrophic duct were also found. One interesting case of aberrant pancreas was presented.