Helicobacter pylori除菌療法による胃MALTリンパ腫の形態変化―内視鏡・X線・病理組織所見の変化について

The Changes of the Endoscopic, Roentgenographic and Pathological Findings of Gastric MALT Lymphoma after Cure of Helicobacter pylori Infection

要旨　胃MALTリンパ腫37例中，Helicobacter pyloriは33例で陽性，4例で陰性と判定された．陽性例全例に除菌療法を施行し31例で除菌に成功，その転帰はCR 11例・PR 17例・NC 3例であった．胃MALTリンパ腫の肉眼所見を内視鏡所見6つ（潰瘍・びらん・cobblestone粘膜・褪色調粘膜・早期胃癌類似病変・粘膜下腫瘤様隆起）に分類した．CR例，PR例とも肉眼所見の多くは1～3か月で萎縮粘膜所見として改善し，その所見は以後長期にわたって持続した．特に胃底腺領域では斑状萎縮粘膜として残存した．その組織所見は，腫瘍細胞が減少・消失し固有胃腺は萎縮して粘膜固有層は空虚となっていた．cobblestone粘膜はPR例のみにみられ，粘膜下腫瘤様隆起はNC例に多くみられた．粘膜下腫瘤様隆起は除菌治療に反応しにくいものと考えられる．

　The relationship between MALT (mucosa-associated lymphoma tissue) lymphomas and Helicobacter pylori (H. pylori) was investigated in 37 patients with special reference to the changes of the endoscopic, roentgenographic and pathological findings of gastric MALT lymphoma after cure of H. pylori infection. Antibacterial treatment consisted of a 1-week course of oral omeprazole, metronidazole and clarithromycin or other regimens. Patients were followed up by means of endoscopy and biopsy. H. pylori was positive in 33 of 37 patients. The overall successful rate of cure of H. pylori infection was 93.9% (31/33). Eleven patients (35.4%) showed complete remission (CR) of lymphoma, 17 (54.8%) partial remission (PR), and three (9.7%) registered no change (NC). Endoscopic appearances of MALT lymphoma were classified into ulcers, erosions, cobblestone appearance, discolored area, lesions like early gastric cancer and polypoid lesions like submucosal tumors. In CR and PR cases, endoscopic appearances changed to atrophic mucosa after cure of H. pylori infection. This atrophic mucosa persisted during the observation period. It could be observed focally in the fundic gland mucosa. Histology showed depletion of tumor cells, atrophic changes of gastric glands and vacant lamina propria. Endoscopy showed a cobblestone appearance only in PR cases and polypoid features predominantly in NC cases.