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要旨 H. pylori陽性の低悪性度MALTリンパ腫においてH. pylori除菌治療後に腫瘍が消失する完全寛解率は84.2%と高く,内視鏡像やIgH再構成の有無による差はなく,有効である.除菌成功後は病変の平坦化と褪色がみられ,寛解後は褪色した萎縮粘膜や瘢痕像のまま再発なく経過し,更に正常粘膜に回復するには数年を要する.除菌後4か月以降も少量の腫瘍細胞が残存する縮小例では組織学的寛解が遅く,更にIgHの再構成の改善は遷延するため次の治療に移る判断が難しいが,内視鏡像が改善すれば急ぐ必要はなく,2年後に消失した例もある.縮小例では,生検偽陰性となる可能性が高いため注意が必要である.なお,完全寛解16例では最長54か月まで再発せず予後は良好であるが,2例に早期胃癌を認めたので,重複癌にも注意が必要である.
Eradication of H. pylori may lead to the complete-remission of gastric low-grade MALT lymphoma both endoscopically and histologically. Out of 19 eradicated cases, 16 cases showed complete-remission (CR 84.2%), two showed partial-remission (PR 10.5%) and one showed no-response (NC 5.3%).
After eradication of H. pylori, the mucosal lesion changed to a flat and discolored area. This flat and discolored atrophy is the characteristic finding of MALT lymphoma in the remission stage. Furthermore, it will take some time, nearly one-year, for the mucosa to regain its normal appearance.
In the follow-up period of 6 to 54 months (average 21 months), neither relapse of MALT lymphoma nor reinfection by H. pylori were observed in complete-remission cases.
On the other hand, a small amount of residual tumor cells and persistence of IgH monoclonality are still observed in three of the partial-remission or no-response cases. No aggravation of the lesion has been observed during a 12-months follow-up period. Therefore, genetic or molecular biology methods are required to determine whether the remission of MALT lymphoma is complete or not.
Chemotherapy is the follow-up treatment of choice for partial-remission or no-response cases. However, the starting period for chemotherapy is hard to determine, because no aggravation is observed during the initial period following partial-remission.
The next problem in the follow-up of MALT lymphoma is to see whether it is in combination with gastric cancer. Two cases of combined malignancy of MALT lymphoma and gastric cancer were observed in our series.
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