Helicobacter pylori除菌治療が奏効しなかった表層型胃MALTリンパ腫の1例

Gastric MALT Lymphoma of the Superficial Type not Regressing after Helicobacter pylori Eradication, Report of a Case

要旨　患者は62歳，女性．当センターの間接胃集団検診にて，胃角部前壁にひだの集中，中断と内部に顆粒状変化を伴った不整形の陥凹性病変を指摘され，要精密検査となった．内視鏡および精密X線検査では，胃角部前壁に白苔を伴った溝状のびらんと，それに囲まれた比較的均一な丸みを帯びた顆粒状変化を認め，また体上部大彎に発赤と小顆粒状変化の目立つ不整形の陥凹性病変を認め，MALTリンパ腫と診断した．生検診断もMALTリンパ腫に一致しており，遺伝子検索でもサザンプロット解析にてIG（H）JHの再構成が認められた．胃生検材料の鏡検とrapid urease testでHelicobacter pylori陽性であった．以上より，Helicobacter pylori陽性表層型胃MALTリンパ腫と最終診断し，除菌治療を行った．胃角部前壁の病変は臨床的に改善を認め，生検もMALTリンパ腫の組織所見は消失していたが，体上部大彎の病変は画像上改善を認めず，生検でも依然としてMALTリンパ腫に相当する所見であり，除菌治療が奏効しなかった症例と考えられた．

　A 62-year-old woman underwent gastric mass survey and it was found that there was convergency and interruption of folds as well as an irregularly-shaped depression with the internal granules on the anterior wall of the angular part. She was followed up by a detailed examination. Endoscopy and x-ray showed that the lesion on the anterior wall of the angular part was characterized by narrow ditch-shaped erosions throughout its circumference and accompanied by whitish coating and roundish, even-sized granules. The lesion on the greater curvature of the upper body revealed an irregularly-shaped depression with internal reddish and small granules. The clinical diagnosis was MALT lymphoma. The biopsy specimen was also MALT lymphoma, compatible. Furthermore, rearranged bands of IG (H) JH were revealed by Southern blot analysis. Rapid urease test of the biopsy specimen was positive for Helicobacter pylori (H. pylori). Based on this data, the lesion was finally diagnosed as MALT lymphoma of the stomach and eradication therapy against H. pylori was performed. Clinical findings of the lesion on the anterior wall of the angular part improved and biopsy findings indicative of MALT lymphoma disappeared. However, in spite of the eradication therapy, endoscopic findings of the lesion on the greater curvature of the upper body showed no sign of improvement and the biopsy specimens were still compatible with MALT lymphoma. It was thus concluded that the H. pylori eradication therapy was ineffective.