中年男性にみられたcollagenous gastritisの1例

Collagenous Gastritis in A Middle-aged Japanese Man, Report of a Case

要旨●患者は50歳代，男性．検診のEGD（esophagogastroduodenoscopy）にて胃体部に限局した粘膜不整を指摘され，精査目的に当科へ紹介され受診となった．胃X線造影検査にて胃体部前壁側に境界不明瞭な陥凹領域を認め，内部に顆粒状隆起を伴っていた．EGDでは胃体部前壁〜大彎にかけて褪色調の陥凹性病変があり，陥凹内に島状に残存する顆粒状隆起を認めた．初回の内視鏡検査では生検組織で診断には至らなかったが，再検査を行い病理医と協議することで上皮下にcollagen bandの肥厚が同定され，最終的にcollagenous gastritisと診断した．本症例はこれまでの報告の中で最高齢で診断に至った．軽微な炎症が慢性的に持続したために病変陥凹内の隆起に過形成様の変化を来したものと考えられ，既報と異なった特徴を持った症例であった．

　A 50s man was referred to our hospital for further assessment of mucosal irregularities in the gastric body observed on EGD（esophagogastroduodenoscopy）during a health checkup. A barium radiograph of the stomach showed an indistinctly demarcated depressed lesion with multiple granular elevations in the anterior wall of the gastric body. EGD revealed a discolored, depressed lesion with multiple granular mucosal islands in the anterior wall and greater curvature of the gastric body. In the initial EGD, histology of the gastric biopsies obtained from the depressed lesion showed only mild atrophic mucosa with chronic inflammation. Histology and serology tests were negative for Helicobacter pylori infection, and the cause of the endoscopic finding was unknown. After follow-up EGD, we discussed the case with the pathologist. Specimens stained with Masson trichrome stain showed mild thickened subepithelial collagen bands. Finally, we diagnosed the patient with collagenous gastritis. This case was the oldest to have been diagnosed to date. The mild and chronic inflammation led to findings of hyperplasia in the granular mucosal islands. Therefore, this case had characteristics different to those of previous reports.