lymphocytic gastritisの1例

Lymphocytic Gastritis, Report of a Case

要旨　患者は34歳，男性．微熱・上腹部痛・食欲不振による8kgの体重減少をみたため，帯広市立病院を受診した．胃内視鏡検査で胃悪性リンパ腫が疑われ，生検では確定診断が得られず当科に紹介された．胃底腺領域，前庭部を中心として胃全体にたこいぼ状隆起が多発していた．生検では非特異的炎症所見のみであった．粘膜切除による組織所見で，上皮細胞内浸潤Tリンパ球の著明な増加が観察されたが，polymerase chain reactionによる遺伝子検索では反応性のものであった．この組織所見とdiffuse varioliform gastritisの臨床像は，Haotらの提唱するlymphocytic gastritisに相当していた．

　A 34-year-old man, complaining of weight loss (8 kg) due to anorexia and epigastralgia, took an endoscopic examination at Obihiro City Hospital. Gastric lymphoma was suspected on the endoscopic findings, which consisted of multiple nodules in various sizes throughout the stomach and slightly enlarged folds in the gastric body. Since a definite diagnosis could not be obtained with endoscopic biopsies, he was referred to our hospital for further examination. Using endoscopy, we also suspected gastric lymphoma or gastric lesions of multiple lymphomatous polyposis. The pathology report from endoscopic biopsy in our department described non-specific inflammation. Helicobacter pylori's infection was not detected on biopsies. Detection of B-cell monoclonality by the polymerase chain reaction showed smear products with two different variable region-primers (Fr 3A and Fr 2A), i.e., a reactive lesion. Endoscopic mucosal resection of a nodule disclosed foveolar hyperplasia, cystic dilatation of glands, and prominent infiltration of lymphocytes into the foveolar epithelium. These intraepithelial lymphocytes and most stromal lymphocytes showed MT1 positive and L 26 negative, namely T-cells. The histologic findings coincided well with the lymphocytic gastritis reported by Haot, et al, together with macroscopic appearance of diffuse varioliform gastritis. Lymphocytic gastritis has attracted considerable attention as a unique gastritis since it appeared in English literature in 1988. It seemed, however, to be a rare condition in Japan because we could not find any case report of Lymphocytic gastritis in Japanese literature.