胃サルコイドの1例

Gastric Sarcoid, Report of a Case

要旨　患者は45歳，女性，人間ドックで胃の異常を指摘され当院受診．皮膚，眼病変なく，胸腹部理学的所見に異常なし．一般血液生化学検査に異常なく，ツ反疑陽性．血沈，梅毒反応，ACEともに正常．胃X線，内視鏡検査で穹窿部に3か所の皺襞集中部を認め，その中央はわずかに陥凹し大小の結節もみられた．体部には粘膜下腫瘍様の小隆起を，また幽門部には胃潰瘍瘢痕様のひきつれ部を認めた．生検で各病変の粘膜固有層内に中心乾酪壊死を伴わない，類上皮細胞肉芽腫を多数認めた．注腸X線検査で回腸終末部まで異常なし．両側肺門リンパ節腫脹なく，経気管支肺生検も異常なかった．以上より胃に限局したサルコイドと診断した．cimetidine 400mg/日で経過観察中であるが，胃部症状なく，8か月後の胃X線検査では初回検査時と変化なかった．

　A 45-year-old female was pointed out to have an abnormality of the stomach by x-ray examination in a clinical survey and visited our hospital.

　She was free of gastrointestinal symptoms and physical examination revealed no abnormality. CBC and blood chemistries were normal. ESR, TPHA test and ACE were all normal with tuberculin reaction being 8×7 mm. Radiological and endoscopic examinations showed following abnormalities: three depressed lesions with converging folds in the fornix, small elevated lesions resembling submucosal tumors in the corpus, and ulcerative lesions resembling ulcer scars in the pylorus. Biopsy specimens taken from each lesion showed non-caseous, isolated epithelioid cell granulomas in the lamina propria mucosae. X-ray examinations of the colon and rectum as well as ileum end were normal. Bilateral hilar lymphadenopathy was not observed and transbronchial lung biopsy showed no abnormality.

　Based on these findings this patient was diagnosed as having gastric sarcoid. Medical treatment (400 mg cimetidine/day) didn't effect improvement in x-ray or endoscopic findings at 8 months.