Helicobacter Pylori除菌により胃粘膜病変の改善を認めた胃MALTリンパ腫の1例

Gastric Lymphoma of Mucosa-associated Lymphoid Tissue which Revealed Improvement of a Gastric Mucosal Lesion by Eradication of Helicobacter pylori, Report of a Case

要旨　患者は62歳，女性．心窩部痛を主訴に難治性胃潰瘍の精査，治療目的で入院した．胃X線検査では，体下部から前庭部にかけてびまん性に拡がる小型の顆粒状陰影と胃角部小彎側から前庭部にかけて不整形のニッシェ様陰影を認めた．内視鏡検査では，粘膜面の敷石状の変化と胃角部から前庭部にかけて散在する不整形陥凹を認めた．超音波内視鏡検査では，胃角部に深達度mp～ssと考えられる潰瘍エコーと体下部から前庭部にかけて第2，3層の肥厚を認めた．生検組織で特徴的なcentrocyte-like（CCL）cellとlymphoepithelial lesion（LEL）を認めたことから，胃MALTリンパ腫と診断した．Helicobacter pylori陽性であったことから，いわゆるItalian regimenによる除菌治療を試み，X線・内視鏡・超音波内視鏡上，胃粘膜病変の著明な改善を認めた．

　A 62-year-old woman was admitted to our hospital due to epigastralgia with a diagnosis of intractable gastric ulcer. Radiographic examination revealed diffuse small sized granular findings which had spread over the antrum from the lower corpus, and irregular niche-like findings which covered the antrum from the lesser curvature of the angulus. Endoscopic examination revealed a cobblestone-like change of the mucous membrane, and scattered irregular depressed lesions which had spread over the antrum from the angulus. Endosonographic examination revealed an ulcer echo at the angulus, which indicated a depth of mp ～ ss, and wall thickness of the second and third layers from the lower corpus throughout the antrum. The diagnosis of gastric lymphoma of mucoua-associated lymphoid tissue was made by histological findings from the biopsy specimens, which also revealed the presence of Helicobacter pylori. After eradication of Helicobacter pylori by the so-called Italian regimen, extreme improvement of the gastric mucosal lesion was revealed from the viewpoint of radiography, endoscopy, and endosonography.