十二指腸球部に嵌入した胃隆起性病変（polypoid lesion）の4例

Polypoid Lesion of the Stomach Prolapsing into the Duodenum: Report of 4 Cases and a Review of Literature in Japan

　最近，胃の隆起性病変（polypoid lesion）はX線，内視鏡検査の進歩および集団検診の普及に従い，従来よりも高頻度に発見されるようになってきている．しかし，このような胃病変が十二指腸内に嵌入することは，比較的まれな現象である．われわれは現在までに過形成性胃ポリープおよびⅠ型早期胃癌の4例について，このような嵌入症例を経験したのでここに報告し，文献上病理学的検索の明らかな47例について，特にその臨床像の検討を加え，併せて治療上の問題点に関しても考察を加える．

　Prolapse of polypoid lesion of the stomach into the duodenum is a rare occurrence.

　Such a prolapsing phenomenon was observed in 4 cases of polypoid lesions of the stomach. Early gastric carcinoma, type Ⅰ, confined in the muscosal layer (m) was found in 3 out of 4 cases. One case (Case 4) presented with 4 polypoid lesions and cancer was found only in the lesion, which was prolapsing into the duodenum. One lesion is still under endoscopic surveillance, since biopsy showed only a hyperplastic polyp.

　In the Japanese literature for the last 25 years, 47 cases with similar prolapsing phenomenon were reported. Most of the patient were older than fifties. Location of the polypoid lesion was either juxtapyloric or at the greater curvature of the antrum. Size of the lesion was greater than 2 cm in about 2/3 of cases. Incidence of accompanying adenocarcinoma in the polypoid lesions greater than 2 cm appears to be increasing for the last 13 years and this fact should be borne in mind to manage these patients.

　From our small experience and from the review of the literature, significance of prolapse-malignancy relationship could not be determined.