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Stomach and Intestine(Tokyo) Volume 44, Issue 5 （April 2009）

胃と腸 44巻5号（2009年4月発行）

Japanese English

今月の主題癌や炎症と鑑別が困難な消化管悪性リンパ腫

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胃MALTリンパ腫の内視鏡所見―早期胃癌や胃炎との鑑別診断 Endoscopic Findings of Gastric MALT Lymphoma 赤松泰次 ¹ , 北原桂 ² , 白川晴章 ² , 市川真也 ² , 長屋匡信 ² , 須藤貴森 ² , 武田龍太郎 ² , 竹中一弘 ² , 太田浩良 ³ , 宮林秀晴 ⁴ , 田中榮司 ² Taiji Akamatsu ¹ , Kei Kitahara ² , Haruaki Shirakawa ² , Shinya Ichikawa ² , Tadanobu Nagaya ² , Takamori Sudo ² , Ryutarou Takeda ² , Kazuhiro Takenaka ² , Hiroyoshi Ota ³ , Hideharu Miyabayashi ⁴ , Eiji Tanaka ² ¹信州大学医学部附属病院内視鏡診療部 ²信州大学医学部消化器内科 ³信州大学医学部保健学科 ⁴独立行政法人病院機構まつもと病院 ¹Department of Endoscopy, Shinshu University Hospital, Matsumoto, Japan ²Department of Internal Medicine, Gastroenteroﾐlogy, Shinshu University School of Medicine, Matsumoto, Japan ³Department of Biomedical Sciences, School of Health Sciences, Shinshu University School of Medicine, Matsumoto, Japan ⁴Internal Medicine, National Hospital Organization, Matsumoto Hospital, Matsumoto, Japan キーワード：胃MALTリンパ腫 , 内視鏡所見 , 鑑別診断 , 早期胃癌 , 胃炎 Keyword: 胃MALTリンパ腫 , 内視鏡所見 , 鑑別診断 , 早期胃癌 , 胃炎 pp.805-812

発行日 2009年4月25日 Published Date 2009/4/25

DOI https://doi.org/10.11477/mf.1403101659

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要旨　当科で診断した胃MALTリンパ腫98例の内視鏡所見を検討した．胃MALTリンパ腫の内視鏡所見は，早期胃癌（IIc）類似型，胃炎類似型，隆起型の3群に大別できた．早期胃癌類似型と早期胃癌の鑑別のポイントは① 正常粘膜との境界が不明瞭，② 蚕食像がないか，あってもごく一部，③ 陥凹内に粘膜模様が観察される，④ 病変が多発することが多い，の4点であった．胃炎類似型はさらに，びらん・潰瘍型，色調変化型，顆粒・結節型に細分類され，びらん性胃炎，急性胃粘膜病変，消化性潰瘍，萎縮性胃炎，鳥肌状胃炎などとの鑑別が必要である．一方，隆起型は，表面にびらんや潰瘍を伴い，形状も不整であることから間葉系腫瘍との鑑別は容易であるが，IIa型早期胃癌や形質細胞腫との鑑別が問題となる．早期胃癌類似型は胃炎類似型に比べて，壁深達度がSM以深の症例が多く（p＜0.01），Helicobacter pylori感染を認めない症例の割合が高かった（p＜0.01）．

　To elucidate the difference in endoscopic findings of gastric MALT lymphoma（GML）and early gastric cancer（or gastritis）, we studied 98 cases of GML. Endoscopic findings of all cases were recognized as superficial type according to Sano's classification. Further, these endoscopic findings could be classified into 3 types ; early gastric cancer（type IIc）-like type（EGC type）GML, gastritis-like type（GI type）, and protruded type（PT type）. Forty-three of 98 cases were classified into EGC type GML, and another 49 cases were GI type. The remaining 6 cases were divided into PT type GML. EGC type GML often looked like IIc type early gastric cancer, but features of endoscopic findings of EGC type GML were as follows ; 1）unclearness of the peripheral margin, 2）lack of moth-eaten appearance, 3）existence of superficial fine pattern, 4）multiple lesions. Endoscopic findings of GI type GML could be subclassified into erosive/ulcer type, change-of-hue type, and granular/nodular type. GI type GML was easily misdiagnosed as erosive gastritis, gastric ulcer, chronic atrophic gastritis, or follicular gastritis because of the similarity of the endoscopic finding. PT type GML should be distinguished from submucosal tumor such as gastrointestinal stromal tumor and IIa type early gastric cancer. No significant difference was recognized between EGC type and GI type GML according to sex, age, affected region, and stage. On the other hand, depth of invasion was significantly limited to within the mucosa in GI type GML compared with EGC type（P＜0.01）, and the positive rate of Helicobacter pylori infection in GI type GML was higher than that in EGC type（P＜0.01）.