膠状稗粒腫の経験—とくにそのゼリー状物質の本態の検索併せて本症の統計的観察について

COLLOID MILTIJM: A CASE REPORT, STATISTIC ANALYSIS AND THE NATURE OF COLLOIDAL SNBSTANCE

　膠状稗粒腫は1866年Wagnerにより初めて記載されて以来，海外では130例余りの報告をみるのに比し，本邦では1923年松本^1）の報告をもつて嚆矢とし，土井^2）の集めた松本^3）（1923），戸沢^4）（1947），島^5）（1956），藤浪^6）（1943），大隅^7）（1955），東大^8）（1961），帷子^9）（1964）の8例のほか，安部ら^10）（1965）の1例を加えて，9例を数えるにすぎない。本疾患の発生機序に関しても全く不明であり，その名称もWagnerのColloidmiliumを初めとして，Pseudomiliumcolloïdale（Arrighi，Wolfram，ら），Kolloid-milien（Marchionini，Luger），Pseudo-kollo-idmilium（Nicolau，Bizzozero），Dégénéresc-ence colloide du derm（Besnierら，Feulardら），Colloidoma miliaris（Jarisch），Pseudo-milo-colloide（Pelizzari，Lombardo，ら），Mi-lium colloide（Pouget，Dubreuilh，ら），Coll-oid milium（Arnord，Robinson，ら），Pseudo　Milium colloidale（Werther），Milium coloi-de（Alvaro Lapa），Degeneratio colloidalis　miliaris（Ketzan），Colloid pseudomilium　（Percivalら），Elastosis colloidalis conglo-merata（Ferreira-Marquesら）等の多数が提唱されている。

　わたくしは最近，膠状稗粒腫の1例を経験したのでこれを記載し，併せて本疾患の統計的観察を試み，かつ病巣部ゼリー状物質の本態解明のために行つた若干の実験成績を記し，その文献的考察を述べたい。

A 48-year-old female farmer having colloid milium has been reported. She had solid, trans-lucent and fawn-colored nodules in crops on the face, especially on the malar eminences. On puncture they discharged soft, gelatinous masses.

Histologic examination with hematoxylin and eosin stain revealed a round homogeneous mass lying in cavities and divided by clefts in the upper dermis. The mass showed slight meta-chromasia with toluidine blue, was violet red by Mallory's azan stain, and was yellowish-brown by Weigcrt-van Gicson's stain. It showed PAS positive in part, but could not be digested by diastase and hyaluronidase.

The routine laboratory examinations were all within normal limits except for slight anemia. Decreased IgA and IgG by the immunoelectrophoresis and decreased 7S fraction of serum globulin by the ultracentrifugation were proved. Column chromatograph of amino acid components of the gelatinous mass revealed none, 4.20% and 5.95% of hydroproline, proline and glycine respectively.

The results from the laboratory studies and chemical analysis of serum protein and gelatin-ous substance suggest that the substance might not be developed from the denatured collagen or elastic fibers, nor from the deposit of scrum protein. It might be related with the ground substance of the dermis.

The results of statistic analysis of the reported cases in Japan are as follows: 1) higher incidence is found in female, 2) ages of onset range from 21 to 50 years of age with the maximum in young and middle ages, 3) the lesions are almost always confined in the exposed areas of the skin, and 4) high incidence occurs in outdoor workers.