低蛋白血症を伴った多発性胃腺型腺腫と考えられた1例

Gastric Gland Type Adenoma Associated with Hypoproteinemia, Report of a Case

要旨　60歳女性．吐血を主訴に来院．入院時検査で貧血と低蛋白血症を認め，上部消化管造影および胃内視鏡検査で胃体部の腺境界領域に弧状に配列する大小不同の多発性ポリープを認めた．生検診断では過形成性ポリープが疑われたが出血持続したため胃切除術を施行．切除胃の組織学的検索ではポリープは間質に乏しく，胃腺窩上皮あるいは幽門腺類似の腺管の腫瘍性増殖を主体としたものであった．以上より同ポリープは喜納らの言う胃腺型腺腫と診断された．また術後血清蛋白の改善をみ，結果的に低蛋白血症は同ポリープよりの蛋白漏出が疑われた．以上，低蛋白血症を伴った胃腺型腺腫と老えられた1例を報告した．

　A 60 year-old woman was admitted to our hospital because of hematemesis and general malaise. On admission she had anemia with hypoproteinemia and hypoalbuminemia (Table 1).

　By x-ray and endoscopic examlnations of the stomach, multiple polyps were detected around the angulus and tear-ropping mucus from those polyps was observed (Fig. 1～4). At this time biopsy specimens taken from those polyps were suspected to be the hyperplastic polyp of the stomach.

　Partial gastrectomy was performed because of continuous hemorrhage from the polyps. Resected specimen showed multiple polyps with varying form and size along the intermediate zone of the stomach (Fig. 5). Histologically those polyps showed strong proliferative activity and poor interstitium, and constituent glandular cell was similar to foveolar epithelium or pyloric glandular cell. Those findings confirmed our suspicion that the polyps were gastric gland type adenomas (Fig. 6～8).

　After surgical operation the hypoproteinemia was improved, Consequently it is considered that the gastric polyps caused the hypoproteinemia.

　The gastric gland type adenoma, having multiplicity and unique form, reported by Kino is very rare and includes adenocarcinoma in high frequency. However, there was no malignancy in this case in spite of serial cutting of the specimen.