20年前に肺病変で発症し胃がん検診にて胃病変を発見されたサルコイドーシスの1例

Gastric Sarcoidosis Associated with Propionibacterium acnes Detected by Gastric Cancer Mass Screening, Report of a Case

要旨●患者は70歳代，女性．20年前から肺サルコイドーシスと診断され，呼吸器内科で経過観察中，胃X線検診にて異常を認め来院した．胃X線検査にて胃体中部後壁に10mm大の透亮像と胃穹窿部大彎にひだ集中を伴う陥凹性病変を認めた．内視鏡検査にて胃体中部後壁に粘膜下腫瘍様隆起，胃穹窿部大彎にひだ集中を伴う白色陥凹を認めた．NBI拡大像では陥凹内に血管のごく軽度な走行異常を認めるも境界不明瞭であった．EUSでは第2〜3層に均一な低エコー域を認めた．生検にて非乾酪性類上皮細胞肉芽腫を認めた．PAB抗体陽性でありアクネ菌との関連が示唆された．大腸内視鏡検査，胸部CTにて異常を認めず，サルコイドーシスの胃病変と考えられた．

　A 70-year-old woman presented with a clinical history of a gastric lesion to our center. She had pulmonary sarcoidosis 20 years ago. Radiological studies revealed a slightly elevated lesion at the middle aspect of the posterior gastric wall. In addition, a depressed lesion causing interruption of gastric folds was found at the greater curvature side of the fornix. Gastric endoscopy revealed a slightly elevated lesion at the middle gastric body and a depressed lesion causing interruption of folds at the grater curvature side of the fornix. Magnifying endoscopy with narrow-band imaging showed slight abnormality of the gastric blood vessels. Endoscopic ultrasound revealed a low echoic lesion at layers 2 and 3. Small non-caseating epithelioid cell granuloma lesion was found on biopsy. Immunohistochemical staining with Helicobacter pylori AB antibody showed positive granules in granulomas of gastric mucosa. No lesion was found on chest CT and colonoscopy. This case was eventually diagnosed as gastric sarcoidosis.