A型胃炎の病理組織学的所見

Pathological Findings of Autoimmune Gastritis

要旨●A型胃炎の病理組織学的所見を明らかにするため，手術9例および生検・内視鏡的切除28例を検討した．A型胃炎の病理組織像は，胃底腺領域の粘膜深部を中心としたリンパ球，好酸球浸潤による壁細胞の破壊・消失に始まる．主細胞は比較的保たれ，偽幽門腺化生の形態をとる．胃底腺が消失すると真の幽門腺化生，腸上皮化生，膵腺房化生に置き換えられる．内分泌細胞過形成も認められる．一方，腺窩上皮の萎縮は軽度で，終末期まで囊胞状変化や過形成を示すことも多い．幽門腺領域では粘膜の萎縮に乏しいが，粘膜内の線維筋症の所見が認められ，胆汁逆流性胃症の所見を呈することも多い．

　To clarify the pathological findings of autoimmune gastritis, we examined 9 surgical and 28 endoscopic cases of biopsy and resection. Initially, lymphocytic and eosinophilic infiltration predominates in the deep mucosa of the fundic gland region, causing the destruction and disappearance of parietal cells. The chief cells are kept relatively, and the fundic glands exhibit pseudopyloric gland metaplasia. When the fundic glands disappear, they are replaced by true pyloric gland metaplasia, intestinal metaplasia, and pancreatic acinar metaplasia. Endocrine cell hyperplasia is also observed. Additionally, the foveolar epithelium demonstrates mild atrophy, cystic changes, and hyperplasia until the terminal stage. In the pyloric gland region, no mucosal atrophy is observed, but findings of bile reflux gastropathy and fibromusculosis within the mucosa is often noted.