多発性異所性胃囊胞症の1例

Diffuse Heterotopic Cystic Malformation of the Stomach, Report of a Case

要旨　多発性異所性胃囊胞症は比較的まれな疾患で，術前診断は困難とされている．今回われわれは超音波内視鏡およびjumbo biopsyで本症と確診した症例を経験したので報告した．患者（38歳，男性）は心窩部痛を主訴に来院．胃X線，内視鏡検査で巨大皺襞を認め，超音波内視鏡を施行．第3層の肥厚と同部に囊胞と思われる無エコー領域の多発を認めた．jumbo biopsyでは粘膜下層に多発囊腫を証明した．本例では癌の合併は認めなかった．本疾患の臨床および組織学的特徴を述べると共に，その発生原因について若干の考察を加えた．

　A 38-year-old man visited our hospital complaining of epigastralgia. The x-ray (Fig. 1) and endoscopic (Figs. 2, 3, and 4) examinations of the stomach revealed swelling folds with a giant one in the greater curvature of the gastric body. Endoscopic ultrasonography (EUS) of the giant fold in the body showed thickening of the third layer in which well-defined, round and anechoic areas with posterior enhancement were gathered (Fig. 5). They were thought to be cystic lesions. The image of the EUS was identified by a jumbo biopsy taken from the giant fold, which microscopically showed many pyloric glands with cystic dilatation in the submucosa and many smooth muscle bundles around cysts (Fig. 6). Furthermore, EUS in the lesser curvature of the gastric body which was free of swelling folds revealed cysts sporadically from the second to the fifth layer (Fig. 5).

　Thus, EUS was thought to be very useful for the diagnosis of diffuse heterotopic cystic malformation of the stomach.