吐下血を来した胃のglomus腫瘍―超微形態学的所見と本邦報告例の集計

Glomus Tumor of the Stomach: Light and electron microscopic study with literature review of the cases reported in Japan

　胃に発生するglomus腫瘍は極めてまれなものとされている．Kay（1951）¹⁾が第1例を発表して以来，外国文献では40症例に満たない．本邦でも，庄司²⁾が1962年第1例を発表しているが，以後22例が報告されているにすぎない^2)～6)．われわれは最近，大量の吐下血を伴った胃のglomus腫瘍を経験し，電顕による検索も行ったので，本邦既報告例について文献的考察を加え，報告する．

　Glaomus tumor of the stomach is rarely seen. According to our investigation of the literature on this subject both abroad and at home, only 40 cases in the foreign countries and 22 cases in Japan, have ever been reported up to the present.

　In this paper is described a case of glomus tumor of the stomach which caused massive bleeding. The patient is a 27 years old woman, who was admitted to hospital because of massive hematemesis and melena. After gastrofluoroscopy, endoscopy and histopathological examination, she was diagnosed to have a submucosal tumor of the stomach with a pit and she underwent the operation.

　In the prepyloric submucosal region, there was a 4×3×3cm-sized, well circumscribed tumor in the muscle layer. The histopathological study of the neoplasm disclosed that it consisted of irregular, swollen blood vessel lumens and many glomus cells.

　Silver-stained specimens showed that these cells were positive for argyrophil fibrile but negative for argentaffin granule by Grimelius' staining method. Ultrastructural study of the specimen revealed that there were two types of tumor cells, i.e. smooth muscle and possible pericytes. From the literature review of ultrastructure of glomus tumors, hemangiopericytomas, leiomyoblastomas and leiomyomas, glomus tumor appeared to exist as an intermediate form between hemangiopericytoma and leiomyomas which were considered to be in a broad spectrum of smooth muscle tumors.

　In this country 22 cases of glomus tumor of the stomach were reported. We attempted in this report to grasp its gross clinical characteristics of these 22 cases.

　Differential diagnosis should include submucosal tumors of the stomach, especially both carcinoid tumor and hemangiopericytoma, for they can often metastasize to other regions.

　It is generally believed the glomus tumor is benign, but since glomus tumors sometimes show pseudoinfiltration and recurrence, which possibly may occur in case of local extirpation, wide resection seems desirable.