胃のreactive lymphoreticular hyperplasiaの1例

Reactive Lymphoreticular Hyperplasia of the Stomach, Report of a Case

要旨　患者は24歳，男性で，心窩部痛を訴え当院を受診した．胃X線検査で，胃体中部から幽門部に粘膜ひだの集中を伴う，広く浅い陥凹性病変を認めた．ひだの先端は陥凹性病変の辺縁で中断していた．内視鏡検査では，陥凹性病変の表面は白色調で，顆粒状を呈する部位もあり，多発性潰瘍瘢痕も認めた．切除胃の肉眼的形態は，Ⅱc型早期癌に類似していた．組織学的には，陥凹性病変およびその他の部位でも芽中心を伴うリンパ濾胞の増生と，小型リンパ球の浸潤が著明であった．しかし，リンパ球に異型性はなく，リンパ濾胞の融合した所見も認めず，また免疫組織学的染色でも多クローン性を呈し，胃RLHと診断した．

　A 24-year-old man visited our hospital complaining of epigastralgia. X-ray and endoscopic examinations revealed a shallow depressed lesion covering a wide area from the middle gastric body to the antrum along the lesser curvature. Multiple folds converging to this lesion were interrupted at the margin of the lesion. We witnessed recurrence of multiple ulcers during 14 months of observation.

　Examination of the biopsy specimen showed many inflammatory round-cells infiltrating and creating lymph follicles. Based on these findings total gastrectomy was performed in February, 1988.

　Gross observation of the resected specimen showed a shallow depressed lesion along the lesser curvature from the middle body to the antrum, with the surface, uneven and granulous. Many ulcer scars were observed in the depressed lesion.

　Histological examination revealed proliferation of atrophic follicles in the regenerated mucosa of the depressed lesion. High power magnification view showed infiltration of lymphocytes without atypia.