梅毒の上部消化管病変―鑑別診断を中心に

Upper Gastrointestinal Tract Lesions of Syphilis

要旨　胃梅毒7例の臨床像，X線・内視鏡像を検討した．また，表層型胃悪性リンパ腫，AGML，スキルス型胃癌との鑑別点を検討した．胃梅毒7例は男性5例，女性2例，平均年齢37.3歳で，梅毒診断の契機は全例胃X線・内視鏡検査であった．胃梅毒のX線・内視鏡像の特徴として，前庭部の漏斗状狭窄，融合傾向のある多発潰瘍，凹凸顆粒状粘膜などが高頻度にみられ，従来の報告と同様であった．また，胃梅毒に特異的と思われる梅毒性皮疹類似のびらん様扁平隆起を7例中2例に認めた．他疾患との鑑別については，①胃悪性リンパ腫では隆起の様相が強く，散在性の多発小潰瘍，びらんを示すことが多い，②AGMLでは皺襞の腫大に比し，粘膜の凹凸に乏しい，③スキルスでは漏斗状狭窄は少なく，多発潰瘍は少ない，などの点から胃梅毒との鑑別は可能と考えられた．

　Seven cases of secondary syphilis with gastric lesions were studied for the assessment of clinical, roentgenographic, and endoscopic features. In addition, we compared the lesions of superficial type gastric lymphoma, AGML, and scirrhous gastric cancer. The initial steps to diagnosis of syphilis in all the cases were upper gastrointestinal (GI) screenings. As reported before, funnel-shaped narrowing of the antrum, granular mucosa with multiple shallow irregular ulcers were frequently observed. Over and above these findings, multiple large verruciform lesions peculiar to syphilis were found in two cases. Useful points for differential diagnosis were as follows: Superficial type lymphoma showed a certain tendency be elevated and, in many cases, showed a scattering of tiny ulcers. AGML showed remarkable swelling of the mucosal folds and a lack of mucosal roughness. Scirrhous cancer rarely showed funnelshaped antral narrowing and multiple ulcers.