Search

A large, poorly demarcated, elevated lesion over the area ranging from the lower end of the esophagus to the lesser curvature of the cardiac region was examined in a 19 year old woman, and demonstrated an irregular and highly infiltrative proliferation of spindle cells over the full thickness of the gastric wall. Although the spindle cells grew mainly in the submucosa, they penetrated the muscularis propria, leaving intact muscle tissue that formed an irregular, island-like pattern, and reached the subserosa. The cells were identified as myofibroblasts by light microscopy, immuno-histochemistry and electron microscopy. The present case is considered to be of an inflammatory pseudotumor due to extremely infiltrative growth of myofibroblasts. This lesion differed from inflammatory fibroid polyp (similarly consisting of proliferating myofibroblasts accompanied by inflammatory cells) in terms of age at onset, tumor size, pattern of cell proliferation and main inflammatory cell component. This report also discusses the relationship between this lesion and a very recently advocated new entity, inflammatory fibrosarcoma of the mesentery and retroperito-neum, which is a tumour closely simulating inflammatory pseudotumor.

症例は34才,女性.主訴は易出血性の口内炎と吐血であり,入院時内視鏡検査で食道に広範な出血性びらんを認めた.口腔粘膜生検組織診で表皮細胞間に水疱形成および棘細胞,また蛍光抗体直接法にて表皮細胞間にIgGの沈着を確認した.経過中全く皮疹なく1年以上病変が粘膜に限局していたため,粘膜天疱瘡と診断した. βメサゾン4mg/日静注8週間で口内炎および食道炎は軽快した.その後の内視鏡検査で早期胃癌が発見され,胃亜全摘術を施行した(胃体中部前壁IIc (4×5cm),深達度m,未分化型腺癌).食道病変および早期胃癌を合併した粘膜天疱瘡は本例が本邦第1例目と思われるので報告する.