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Stomach and Intestine(Tokyo) Volume 42, Issue 8 （July 2007）

胃と腸 42巻8号（2007年7月発行）

Japanese English

今月の主題胃MALTリンパ腫―除菌無効例の特徴と治療戦略

主題

除菌無効胃MALTリンパ腫の臨床的特徴―画像所見を中心に Clinical Characteristics of H. pylori Eradication Resistant Gastric MALT Lymphoma with Special Reference to Rentogenographic, Endoscopic and EUS Findings 中村常哉 ¹ , 田近正洋 ¹ , 河合宏紀 ¹ , 瀬戸加大 ² , 横井太紀雄 ³ , 谷田部恭 ³ , 中村栄男 ⁴ Tsuneya Nakamura ¹ , Masahiro Tajika ¹ , Hiroki Kawai ¹ , Masao Seto ² , Takio Yokoi ³ , Yasushi Yatabe ³ , Shigeo Nakamura ⁴ ¹愛知県がんセンター中央病院内視鏡部 ²愛知県がんセンター中央病院研究所遺伝子医療研究部 ³愛知県がんセンター中央病院遺伝子病理診断部 ⁴名古屋大学医学部附属病院中央検査部病理 ¹Department of Endoscopy, Aichi Cancer Center Hospital, Nagoya, Japan ²Division of Molecular Medicine, Aichi Cancer Center Research Institute, Nagoya, Japan ³Department of Pathology and Molecular Diagnosis, Aichi Cancer Center Hospital, Nagoya, Japan ⁴Department of Pathology and Clinical Laboratories, Nagoya University Hospital, Nagoya, Japan キーワード：胃MALTリンパ腫 , API2-MALT1 , H. pylori , 除菌療法不応例 Keyword: 胃MALTリンパ腫 , API2-MALT1 , H. pylori , 除菌療法不応例 pp.1198-1206

発行日 2007年7月25日 Published Date 2007/7/25

DOI https://doi.org/10.11477/mf.1403101151

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要旨　胃MALTリンパ腫の病態は除菌療法の反応性とAPI2-MALT1の有無から3群に分けられる．responderでAPI2-MALT1陰性のA群，non-responderでAPI2-MALT1陰性のB群，non-responderでAPI2-MALT1陽性のC群であり，その特徴は次のようである．A群：H. pylori陽性，深達度SMまで，臨床病期I期，潰瘍や早期胃癌類似の肉眼型．B群：H. pylori陰性，深達度MP以深，リンパ節転移陽性，臨床病期II₁期以上，高悪性度成分あり，隆起型．C群：男性，H. pylori陰性，cobblestone粘膜，高悪性度成分なし．除菌不応例の予測因子は，臨床病期II₁期以上，API2-MALT1陽性，H. pylori陰性，深達度MP以深，隆起型，cobblestone粘膜であった．除菌不応例に対する二次治療は有効であり，その予後も良好であった．しかしAPI2-MALT1陽性例を二次治療なしで経過観察する場合，胃癌の発生や病期の進行に注意が必要である．

　Clinicopathologic characteristics of H. pylori eradication resistant gastric MALT lymphoma are not well clarified. We analyzed a consecutive series of gastric MALT lymphoma at our institution with special reference to rentogenographic, endoscopic and EUS findings. Subjects were 92 consecutive patients with gastric MALT lymphoma. Gastric MALT lymphoma was classified into three groups: responders without API2-MALT1 (group A), non-responders without API2-MALT1 (group B) and non-responders with API2-MALT1 (group C). Clinicopathologic features of each group can be summarized as follows. Group A: H. pylori-positive, no invasion beyond the submucosa, clinical stage I, and macroscopic ulceration and early gastric cancer-like appearance. Group B: H. pylori-negative, invasion to the proper muscle layer or deeper, lymph node metastases, clinical stage II₁ or higher, and protruding lesion. Group C: Male preponderance, H. pylori-negative, absence of DLBCL component, and cobblestone-like mucosa. According to multivariate analysis, predictive factors of a non-responder were II₁ or more in clinical stage, positive API2-MALT1, positive H. pylori, proper muscle or more in depth of invasion, protruded lesion and cobblestone mucosa. For non-responsive cases, second-line treatments resulted in complete response (CR). However, careful observation for development of gastric carcinoma and disease progression is essential during follow-up of API2-MALT1 positive gastric MALT lymphoma when patients refuse second-line treatment.