胃アミロイドーシスの形態的検討

Morphological Study of the Stomach with Amyloidosis

要旨　皮膚アミロイドーシスと診断された患者45例に上部消化管内視鏡検査を行い，22例（48.9％）に上部消化管にもアミロイドの沈着を認め，胃アミロイドーシスのいわゆる初期像と考えられる内視鏡像を観察した．アミロイドは胃の前庭部からの生検でやや多く得られ，その部には発赤，隆起，凹凸が認められた．アミロイド沈着の認められた22例の内視鏡像を見直すと，明らかな異常所見のない例のほか，発赤，びらん，小顆粒状隆起，点状出血，浮腫状粘膜などの微細な変化が認められた．最後に胃アミロイドーシスの終末像として幽門前庭部の狭窄，巨大皺襞，胃蠕動停止の例を呈示した．

　We described here endoscopic findings of the stomach in the early stage of amyloidosis. Upper gastrointestinal endoscopy was performed in 45 patients with cutaneous amyloidosis. Following the endoscopic observation, biopsy specimens were obtained in all cases for electronmicroscopic investigation. Twenty-two out of 45 patients were diagnosed as having gastric amyloidosis, Portions of the stomach deposited with amyloid were gastric body in nine cases, antrum in twelve cases, and duodenal cap in three cases. Endoscopic findings included the foilowing fine mucosal abnormalities: red spots, gastric erosion, nodular elevation, petechia and mucosal edema. No abnormalities, however, were found endoscopically in four cases. Gastric lesions in the end stage of amyloidosis in two cases included narrowing of the antrum, giant rugae and diminished peristalsis.