Helicobacter pylori除菌治療により完全寛解した後，局所再発したMALTリンパ腫の1例

Gastric Low Grade MALT Lymphoma with Local Recurrence after Complete Remission by Eradication Therapy, Report of a Case

要旨　患者は55歳の男性．吐血を主訴に来院．緊急内視鏡検査にて止血術を受けた後，再検時の生検組織所見でMALTリンパ腫が疑われた．内視鏡所見では胃体下部後壁に周辺隆起を伴う潰瘍を認め，生検組織所見でびまん性に浸潤するcentrocyte-like cellとlymphoepithelial lesionがみられた．細菌培養と組織所見でHelicobacter pylori（Hp）を認め，Hp陽性の胃MALTリンパ腫と診断した．3剤併用療法による除菌療法を行ったところ，Hpは陰性化し，治療後6か月目の内視鏡および生検組織所見で完全寛解（CR）と考えられた．CR確認後1年10か月目に腹痛を訴えて来院し，内視鏡所見で周辺に隆起を伴う潰瘍が認められ，生検組織所見からMALTリンパ腫の局所再発と考えられた．Hpは陰性であった．CHOP療法3クールおよび30Gyの放射線療法を行い，その後1年8か月再発を認めていない．

　A 55-year-old man was referred to Shinshu University Hospital in October, 1997, for further examination and treatment of gastric lymphoma. He first underwent emergent endoscopic examination because of hematemesis in the National Nagano Hospital, which indicated gastric continuously ulceration with visible vessel. He received endoscopic hemostasis continuously. The biopsy specimens strongly suggested a malignant lymphoma of the stomach, so he was referred our hospital. Endoscopic examination revealed multiple ulcerations and discolored change with an elevated lesion on the posterior wall of the lower gastric body. The biopsy specimens showed diffuse centrocyte-like cells, and lymphoepithelial lesions. Immunophenotypic studies of the biopsy specimens of the stomach using monoclonal antibody were suggestive of B-cell MALT lymphoma. Helicobacter pylori (Hp) was detected by immunohistological tests and cultures. The patient was diagnosed as stage 1A primary gastric low grade MALT lymphoma, according to the Ann Arbor classification. He was cured of Hp infection by triple therapy using lansoplazole, amoxicillin, and metronidazole for 14 days. Complete remission of gastric MALT lymphoma was recognized in both endoscopic and histological findings 6 months after the eradication therapy. 27 months after eradicatinon therapy, he visited our hospital again, complaining of epigastric pain. Endoscopic examination revealed irregular ulceration surrounding a submucosal elevation in almost the same region. The biopsy specimens showed infiltration of atypical lymphoid cells, and Hp was negative. From these findings, we thought that this lesion was a local recurrence of MALT lymphoma. Combination therapy of chemotherapy consisting of 3 courses of CHOP and 30 Gy of radiation therapy led to re-remission. The patient has had no recurrence for 20 months since the chemo-radiation therapy.