胃生検によって迷入膵と確診できた胃粘膜下腫瘍の1例

A Case of a Submucosal Tumor of the Stomach Confirmed by Biopsy as Aberrant Pancreas

　胃生検は診断の最終評価を決定する不可欠な検査法にまで進歩してきたが，しかし胃粘膜下腫瘍に対してはこれら病変の占居部位と生検鉗子の到達深度から判断して当然のことながら無力とさえいわれている．

　われわれは最近，十二指腸潰瘍による幽門狭窄症に合併した胃壁迷入膵を生検により確定診断しえた興味ある1例を経験した．

　Progress of gastric biopsy has now made it an indispensable procedure in the final evaluation of gastric lesions whether a given diagnosis is completely accurate or not. Nonetheless, it is as yet totally incompetent in the face of submucosal tumors. In this respect, our report is of interest because we were able to confirm through biopsy aberrant pancreas in the gastric wall attending on pyloric stenosis caused by duodenal ulcer.

　Roentgenologic examination of a man 40 years of age revealed pyloric stenosis due to duodenal ulcer along with a submucosal tumor in the greater curvature side of the pylorus. Target biopsy disclosed pancreatic tissue within it, so that a diagnosis of aberrant pancreas of the stomach was made. Our success in diagnosis seemed to lie in the correct biopsy of that part of heterotopic tissue of the pancreas, mostly developing in the submucosa, which was raised up into the mucosa.

　According to histopathologic investigation of Nagayo et al., aberrant pancreas in the stomach chiefly develops in the submucosal layer or muscular coat, and in about one fourth of cancreatic acini are to be found in the mucosa as well. This suggests that heterotopic pancreas of the stomach, generally classified as submucosal tumor, can also be diagnosed correctly if the site of biopsy is not beside the mark.