Iwafuchi M, Watanabe H, Shiratsuka M
First Department of Pathology, Niigata University School of Medicine, Japan.
Am J Surg Pathol. 1990 May;14(5):489-96. doi: 10.1097/00000478-199005000-00010.
A 49-year-old Japanese woman was found to have innumerable, small sessile elevations throughout the stomach as revealed by radiographic and endoscopic examination. Endoscopic biopsy showed that the elevations were formed by a diffuse proliferation of histiocytes in the lamina propria mucosae. The histiocytes were characterized by abundant interdigitating cytoplasmic projections, Birbeck granules, an oval or indented nucleus, and an absence of phagocytosis. They stained for S-100 protein but not for lysozyme, alpha-1-antitrypsin, or nonspecific antigen cross-reacting with carcinoembryonic antigen. Five and a half years after the first diagnosis, most of the elevated lesions disappeared, but a few histiocytoid cells were noted microscopically. Systemic examination showed no abnormalities outside the stomach. The patient has continued to be well. This case was diagnosed as primary benign histiocytosis X of the stomach. Four similar cases have been reported. This is the first case that was diagnosed using biopsy techniques and in which the natural history--i.e., from multiple polypoid extension throughout the stomach to spontaneous remission--was observed.
一名49岁的日本女性经影像学和内镜检查发现胃内有无数小的无蒂隆起。内镜活检显示，这些隆起是由黏膜固有层中组织细胞的弥漫性增生形成的。组织细胞的特征为有丰富的指状胞质突起、伯贝克颗粒、椭圆形或凹陷的细胞核，且无吞噬作用。它们对S-100蛋白呈阳性染色，但对溶菌酶、α-1抗胰蛋白酶或与癌胚抗原交叉反应的非特异性抗原呈阴性染色。首次诊断五年半后，大多数隆起病变消失，但镜下仍可见少数组织细胞样细胞。全身检查显示胃外无异常。该患者一直状况良好。此病例被诊断为胃原发性良性组织细胞增生症X。已有4例类似病例报道。这是首例通过活检技术诊断且观察到其自然病程（即从胃内多发息肉样扩展到自发缓解）的病例。
