Helicobacter Pyloriの除菌療法により改善が認められた胃MALTリンパ腫の1例

Mucosa-associated Lymphoid Tissue (MALT) Lymphoma which Improved after Eradication Therapy for Helicobacter Pylori Infection, Report of a Case

要旨　55歳の女性．空腹時上腹部痛を主訴として来院した．幽門前庭部に多発の潰瘍とびらん，壁伸展不良を認めたが初年度には確診がつかず来院が中断した．1年後に再び上腹部痛を訴えて来院し，潰瘍の増悪と新たな粘膜下腫瘍隆起を認め，生検でmucosa associated lymphoid tissue（MALT）リンパ腫と診断され，分子生物学的にもmonoclonalityが確認された．Helicobacter pylori（HP）が陽性であり，lansoprazole 30mg，clarithromycin 400mg，plaunotol 240mgの8週間投与を行い，潰瘍は治癒し生検でリンパ腫陰性となった．粘膜下腫瘍隆起の消失は3か月後に認めた．HPは免疫染色で依然として少数認めたが，18か月間の経過観察でリンパ腫の再発は認めていない．

　A 55-year-old female visited Yamaguchi clinic complaining of an epigastric pain when hungry. X-ray examination (Fig. 2 a) and three upper gastrointestinal (GI) endoscopies (Fig. 3) revealed multiple irregular-shaped ulcerations and poor-extensibility of the antrum, which strongly suggested malignant lymphoma. But the histological diagnosis of the biopsy specimens did not confirm malignant lymphoma at that time. Because her epigastric pain disappeared, she ceased to visit the clinic of her own accord. One year later, she was referred to the clinic again because of epigastric pain. X-ray examination (Fig. 2 b) and upper GI endoscopy (Fig. 4) showed aggravated ulcerations and a submucosal tumor with a central ulceration which had not been recognized in the previous examination. Pathological study including immunohistochemical staining (Fig. 5 c, d) and molecular biological examination (Fig. 6) using biopsy specimens revealed mucosa-associated lymphoid tissue lymphoma, and Helicobacter pylori was also detected (Fig. 5 b) . After eight weeks administration of 30 mg of lansoprazole, 400 mg of clarithromycin and 240 mg of plaunotol, multiple ulcerations were healed (Fig. 7), and pathological study revealed no lymphoma cells. Three months after eradication therapy ceased, the submucosal tumor disappeared completely (Fig. 8) . Although eradication of Helicobacter pylori did not succeed, no sign of recurrence of lymphoma has been detected during the 18 months since eradication therapy ceased.