胃に限局したアミロイドーシスの1例―6年間の経過観察

Amyloidosis Localized at the Stomach, Report of a Case

要旨　原発性アミロイドーシス，多発性骨髄腫に伴うアミロイドーシス，二次性アミロイドーシス，遺伝性アミロイドーシスにおける胃アミロイドーシスの合併は多い．しかし本症例のごとく，胃に限局しているアミロイドーシスの報告は少なく，調べた範囲では，7例を数えるのみである．これら7例のうち，第4例が吐血のため緊急手術となり，術後に診断されており，他6例のうち第6例を除いて，術前診断が“胃悪性腫瘍”で術後に診断されている．胃アミロイドーシスのX線所見は，スキルス様所見を呈する場合と，腫瘤形成所見を呈する場合がある．本症例はスキルス様所見を呈し，胃生検にて診断し，6年間経過を追っているが，所見に変化はない．

　A case of amyloidosis localized at the stomach in a 76 year-old woman who had been complaining of anorexia and abdominal fullness, was reported. Amyloid infiltration of the gastrointestinal tract has been reported frequently in primary amyloidosis, amyloidosis with multiple myeloma, secondary amyloidosis and familiar amyloidosis. But, amyloidosis localized at the stomach is very rare. The present case is believed to be only the eighth case to be presented (Table 3). Amyloid deposits in the gastric mucosa occasionally appear as polypoid masses, and can therefore mimic cancer. Amyloidosis is another process that may lead to narrowing and irregularity of the stomach, mimicking scirrhous type carcinoma. The roentgenographic picture is not very specific, and many authors pointed out the difficulty in differential diagnosis between localized gastric amyloidosis and gastric malignancy. Therefore, inaomost all of amyloidosis localized at the stomach, thediafnosis has carcinoma or been gastric malignant tumor. The roentgenographic picture of this case appears to be mimicking scirrhous type carcinoma, and we diagnosed it by biopsy following endoscopic examination (Fig.3, 4). We have followed up this case for six years, and no changes have been found in roentgenographic findings (Fig. 1, 2).