巨大皺襞と胃血管腫の共存例

A CASE OF GASTRIC HEMANGIOMA ASSOCIATED WITH GIANT MUCOSAL FOLDS

Ⅰ．はじめに

　胃に発生する腫瘍はその大部分が癌腫で癌腫以外の悪性腫瘍，あるいはポリープ以外の良性腫瘍はいずれも少ない．なかでも胃血管腫は極めて稀で本邦では数例の報告があるにすぎない．また巨大皺襞は蛋白喪失の観点から近年特に注目されるようになり，Ménétrier's diseaseと言われる蛋白喪失性胃炎とそうでないものとに分けられるが，その本態はなお明らかでない．

　われわれは胃の広範な領域にわたり巨大皺襞を伴った胃血管を経験したので若干の文献的考察を加えて報告する．

　A 66-year-old housewife, having no subjective complaint, was nevertheless found by a gastric mass survey to harbor gastric cancer. Subsequent thorough examination revealed giant mucosal folds in her stomach. Besides the fact that gastric cancer could not be excluded completely, her blood showed hypoproteinemia (serum protein 4.9 g/dl), so that surgical intervention was decided on. X-ray study of her stomach showed rigid and irregular contours of both curvatures in barium-filled picture from the corpus way down to the pylorus associated with widening of the gastric angle. In supine double contrast study, several giant mucosal folds, serpentine and winding, were seen to descend directly from the cardiac orifice. Gastric endoscopy disclosed big mucosal folds, formed as of the gyri in the brain. In the gross resected specimen were observed hypertrophied, serpentine mucosal folds extending from the cardia to the whole area of the corpus at the level of the incisura, all drawn up like green caterpillars. Histologically cavernous hemangioma was found in the submucosal layer in a very wide area, partly extending to the muscle layer as well. Hemangioma was not only found in an extensive area in the submucosal layer, corresponding in its site to the giant rugae, but also in thin portion of the submucosal layer. In other words, hemangioma was in such a state as to extensively spread horizontally in the submucosal layer. It was impossible therefore to establish a causal relation between the unevenness of the gastric mucosa and hemangioma by the study of this specimen alone. Perhaps hemangioma and giant rugae coexsisted incidentally. Perhaps not. Details are not to be recognized as yet. Ten days after the operation the serum protein levels rose up to 7.0 g/dl. With no symptoms to complain of, she is having favorable progress toward recovery.

　Gastric hemangioma in an extensive area associated with giant mucosal folds of the stomach is reported in this paper with some reference to its literature.