副膵より発生した胃粘膜下嚢腫の1例

A Case of Submucosal Cyst of the Stomach Originating in the Heterotopic Pancreas

　筆者らは最近5年間の上腹部手術例341例中4例の副膵を経験した．この中，副膵が胃にあったもの3例，空腸にあったもの1例で，胃壁迷入副膵は同期間の手術全胃腫瘍105例に対し2.8％，胃良性腫瘍24例に対して12.5％となる．その2例はすでに津島ら¹⁾によって報告されているが，ここでは多発性胃潰瘍を伴い胃粘膜下嚢腫を形成した最近の1例を報告し，あわせて胃嚢腫，特に胃壁迷入膵嚢腫について若干の考察を試みることとしたい．

　A case of gastric submucosal cyst is described originating in the accesory pancreas in the gastric wall associated with multiple gastric ulcers. A reference has also been made to a review of the literature of the gastric cysts, especially those due to heterotopic pancreas in the gastric wall.

　Case: a 28-year-old man, complaining of epigastralgia.

　At x-ray examination, a sharply circumscribed shadow defect was seen occupying almost the entire area of the pyloric antrum. Gastroscopy revealed in the corresponding site a flat, hemispheric protrusion accompanied with multiple small ulcers. In the resected stomach a unilocular cyst 4.5×5.2×1.2 cm in size, was observed in the pyloric antrum. On its mucosal surface as well as on the lesser curvature at the gastric angle and on the greater curvature side of the corpus were seen each small ulcers the size of rice grain. The cyst contained brownish fluid measuring about 25 ml, showing high amylase levels. No tripsin activity was demonstrated, however. Histologically, the epithelia of the cystic wall have almost fallen off, disclosing inflammatory granulation tissues instead. Only in a small part were cuboidal epithelia preserved. On the pyloric side of the cyst was seen aberrant pancreas belonging to Heinrich type II. Its excretory duct was delated. This case seems to show that inflammatory occlusion of the excretory ducts of the aberrant pancreas in the gastric wall, along with excretory acitivity more or less well sustained in the cells of the aberrant pancreas, resulted in the formation of a cyst. The incidence of benign gastric tumors is 22.8 per cent in the authors’ operated cases of gastric tumors. Gastric cyst has never been met before. It accounts for 4.1 per cent of benign gastric tumors.