興味ある所見を示した胃アニサキス症の1例

A Case of Gastric Anisakiasis Showing Interesting Findings

　胃寄生虫性肉芽腫症の代表的疾患として胃アニサキス症がある．本症は胃壁内に硬結や腫瘤を形成する限局性病変のことが多いが，著者らは最近，胃スキルスを疑い手術したところ，切除標本は広範なびまん性の胃壁肥厚を示し，組織学的に胃アニサキス症であった興味ある1例を経験したので報告する．

　Most of reported gastric anisakiasis formed localized lesions in the gastric wall. It is of interest that the case described here showed diffuse thickening of the gastric wall.

　Case: A 58-year-old man complaining of pain of epigastrium. examination of the stomach revealed rigidity and lack of distensibility at the greater curvature from the mid body to pylorus. Endoscopic examination disclosed the rigidity of the gastric mucosa with irregularly swollen mucosal folds on the anterior and posterior walls, and the greater curvature from the mid body to pylorus. But erosion or ulcer was not found. Althrough gastric biopsy demonstrated no malignant lesion of the mucosa, laparotomy was performed under the suspicion of scirrhous carcinoma. There were greyish patches on the serosa of the greater curvature involving the major omentum, and markedly swollen lymph nodes along the both curvatures. Subtotal gastrectomy with extirpation of lymph nodes was done. The resected stomach showed diffuse thickening of gastric wall from the mid body to pylorus. Histopathological examination revealed widespead eosinophilic granulomatous and phlegmonous inflammation extending from the submucosa up to the serosa. A microscopic abscess was found in the deep submucosal tissue on the greater curvature of the antrum. There were cicatrized granulomatous tissue around the abscess and a destroyed cuticule in the center of it, which was considered to be belonged to anisakis larvae.