迷入膵を伴った胃神経線維腫の1例

A Case of Neurofibroma of the Stomach Associated with Aberrant Pancreas

　胃粘膜下腫瘍のうちでも神経線維腫は比較的まれな疾患であるが，筆者らは最近，胃前庭部に胃壁内迷入膵と併存した胃神経線維腫の1例を経験したので報告する．

　Case: a 62-year-old female.

　Since two years before she had come to complain of loss of appetite and postprandial unpleasant sensation in the epigastrium. X-ray study in the bariumfilled stomach revealed on the greater curvature of the antrum a niche-like protrusion with marginal irregularity. Double contrast study also disclosed an irregular-shaped shadow fleck on the posterior wall of the antrum surrounded with marginal elevation. In pressure films a protrusion with central concavity was visualized on the greater curvature of the antrum. A kidney-shaped protrusion with smooth surface was seen there as well on the lesser curvature. It was associated with bridging folds. Endoscopy revealed a papillar elevation with navel-like central depression on the greater curvature of the antrum. Its surface was smooth and there was no difference of color between it and the surrounding normal mucosa. A low broad-based protrusion was also seen on the posterior wall of the same segment in the lesser curvature side. Its surface was likewise smooth without any white coat adhesion or bleeding.

　Resectecl stomach showed a plateau-like elevation, measuring 1.3×1.1cm, on the posterior wall of the antrum near the lesser curvature. Another elevation was also seen there on the greater curvature, measuring 1.4×1.4cm and its tip bent toward the pylorus. It had a central depression 0.8 cm in diameter.

　Histologically, the elevation on the lesser curvature proved to be a submucosal neurofibroma, sharply circumscribed and adjacent to the muscularis mucosae with no covering. The other elevation on the greater curvature was due to submucosal aberrant pancreas, located in the base of a dimple in the elevation. The aberrant pancreas consisted of excorine glands of varying size, a small number of islets of Langerhans, smooth muscle fibers, etc.

　Neurofibroma of the stomach in association with aberrant pancreas within it seems to be of such a rare occurrence that it has never been reported in the literature we have investigated.