胃粘膜下囊胞の1例

A CASE OF SUBMUCOSAL CYST IN THE STOMACH

Ⅰ．はじめに

　胃内視鏡の進歩にともなって，最近では胃の粘膜下腫瘍のあるものではその組織診までも内視鏡的に診断することがある程度可能となってきた．粘膜下囊胞も内視鏡的にかなり特徴的であり，他の粘膜下腫瘍との鑑別が比較的容易と考えられるが，最近の綜説¹⁾²⁾³⁾の中にもこの点を強調した論文はほとんどみあたらない．最近著者らは胃粘膜下囊胞の1例を経験したので報告する．

　This is a case report of a submucosal cyst of the stomach. A woman 44 years old was admitted to the hospital on account of dull pressure feeling in the epigastrium, sometimes felt since a few years ago. At x-ray examination of the stomach, a rather ill-defined, oval shadow defect the size of a quail's egg was demonstrated in the center of the anterior wall in the antrum. Endoscopically a submucosal tumor, looking as if of soft consistency, was found in the above area, its contour slightly changing according to oncoming peristalsis. Resected stomach disclosed that the tumor, measuring 4.5×2.5×1.3 cm, was a submucosal cyst, later histologically diagnosed as a lymphangioma dilated like a cyst.

　The number of reported cases of gastric cyst in this country amounts to 41, including this case, and of these there have been only 13 cases of lymphatic cysts (inclusive of cystic lymphangioma). Nine out of 13 were located in the submucosal layer, with 4 in the subserosa.

　Endoscopical picture of a gastric submucosal cyst is fairly characteristic. Besides general features of a submucosal tumor, (1) it looks much softer as compared with such a tumor as leiomyoma, and (2) it has only a few typical bridging folds, with (3) no depression in the center of the tumor, having (4) sometimes pellucidity against light. When (5) it is touched by biopsy forceps or by ejected washing fluid, the surface of the tumor at times depresses a little or it may show fluctuation. Lastly (6) the content within the tumor may ooze out through an aperture artificially made by biopsic maneuver. The tumor may completely disappear then.

　When these characteristic features of this tumor are well borne in mind, its preoperative diagnosis may become possible.