胃結核の1例

Tuberculosis of the Stomach, a Case Report

　胃結核は数ある胃疾患でもきわめて稀な疾患である．われわれは胃癌の診断の下に手術を行ない，術後病理学的に胃結核と診断した症例を経験したので報告する．

　A 64-year-old woman had begun to complain of occasional vomiting over the past 8 years. Even a diagnosis of gastric cancer was made by x-ray examination 6 years before, but she let it alone. Finally she decided to visit our hospital in December 1972 because of pain in the back troubling her since a short while before. X-ray revealed marked shortening of the lesser curvature along with an extensive area of uneven and irregular mucosal surface centering around the lesser curvature. Endoscopy showed the entire area in an eroded state with multiple shallow ulcers here and there. A diagnosis of gastric carcinoma was then made.

　Grossly the resected stomach showed hypertrophic and rigid mucosa all along the whole length of the lesser curvature. The mucosal surface was rough, uneven and of fine granular appearance, dotted with many shallow ulcers and erosions. Histologically, at the sites of the ulcers were seen tuberculous lesions showing caseation necrosis, epithelioid cells and Langhans' giant cells. Tubercles were seen scattered about both in the lamina propria and submucosa. Cellular infiltration including neutrophils, plasma cells and lymphocytes was of very high degree. Tuberculous lesions were also recognized in the supraclavicular lymph nodes and ascending colon.

　Gastric tuberculosis is a disease rarely encountered. In our country only 83 cases have been reported up to December 1973. Its diagnosis seems difficult. Of 28 cases reported during the last 8 years, only 3 cases were preoperatively diagnosed as such. Nonetheless, we should have suspected it in view of the fact that she had been diagnosed as harboring cancer of the stomach as long as 6 years before, let alone tuberculous change noticed in the supraclavicular lymph nodes.

　Tuberculosis of the stomach is usually classified into various types, but in our case it was hardly possible to do so because the whole picture was too variegated to fit it into a single type, what with marked hypertrophy and rigidity of the wall, and what with extensively abnormal mucosal surface dotted with a number of shallow ulcers and erosions.

　The route of infection, too, presumably either direct or vascular, could not be ultimately determined.