内視鏡的切除を施行した限局性肥厚性胃炎の1例

Localized Hypertrophic Gastropathy Identified by Endoscopic Resection, Report of a Case

要旨●患者は40歳代，男性．胃体下部前壁に40mm大の隆起性病変を認めた．立ち上がりは明瞭で，表面は大脳回状であった．NBI併用拡大内視鏡検査では，病変部と周囲粘膜との間に明瞭な境界はみられず，微細表面および微細血管構造に不整は認めなかった．非腫瘍性病変を疑ったが，病変が40mm大であり，立ち上がりが明瞭であることから腫瘍を完全に否定できず，ESDを施行した．病変は，成熟した腺窩上皮と体部腺から成り，周囲粘膜よりも2.6〜2.7倍厚く，腺窩上皮と体部腺の厚さ（丈）の比は周囲粘膜と同様に約1：3であったため，限局性肥厚性胃炎と診断した．肥厚性胃炎は，皺襞がびまん性に巨大に肥厚する病変だが，まれに限局性にみられることがある．

　Hypertrophic gastritis usually occurs as a diffuse lesion with enormously thickened gastric mucosal folds, but localized cases have occasionally been reported.

　We present a case of a 40-year-old man. Endoscopic examination revealed an elevated lesion of 40mm in the anterior wall of the lower part of the body. The boundary of the lesion was clear, and the surface resembled cerebral gyri. Magnifying endoscopy with narrow-band imaging showed an unclear demarcation line. Both microsurface and microvessel patterns were regular. We employed endoscopic submucosal dissection to remove the lesion because of its size（40mm）and irregular shape. Pathological examination of the lesion revealed normal foveolar epithelium and fundic glands that were 2.6-2.7 times the thickness of the surrounding mucosa. The ratio of the foveolar epithelium thickness to the gland thickness was approximately 1：3 and this was similar to that of the surrounding mucosa. Based on these results, the lesion was diagnosed as localized hypertrophic gastritis.