胃reactive lymphoreticular hyperplasiaの経過観察中に見出された胃悪性リンパ腫の1例

Coexistence of Malignant Lymphoma of the Stomach and Hodgkin's Disease, Report of a Relatively Long-term Follow-up Case

要旨　患者は74歳，男性．心窩部痛を主訴に来院．胃X線および内視鏡検査で多発潰瘍を伴う顆粒状粘膜を認め，生検組織像と併せ胃RLHと診断した．3年10か月間の経過観察後，体下部の不整形潰瘍の生検で悪性リンパ腫と診断，胃全摘術を施行した．切除胃の肉眼所見では，体部に多発潰瘍瘢痕を伴う粗糙な粘膜と共に体下部大彎，前庭部小彎に丈の低い小隆起を認め，組織学的には悪性リンパ腫（非ホジキンリンパ腫，びまん性，大細胞型）とRLHの並存と診断した．また，胃周囲リンパ節にはHodgkin病の組織像を認め，広義の複合リンパ腫に相当すると考えた．本例は胃RLHの悪性化を示唆する貴重な症例と考えられた．

　A 74-year-old male visited our hospital in May 1984 with a 6-month history of occasional epigastralgia. Radiographic and endoscopic study of the stomach revealed granular mucosa with multiple shallow ulcers and erosions in the gastric body. Histology of the biopsy specimen showed lymphocytic proliferation forming many lymphoid follicles. There was no evidence of malignancy. The patient was carefully followed up as reactive lymphoreticular hyperplasia (RLH) for three years and ten months. In December 1987, an ulcer of irregular shape appeared in the lower body. The histological findings of the biopsy specimen of this ulcer showed malignant lymphoma. In January 1988, the patient was admitted to our hospital, and total gastrectomy was performed in March 1988. Macroscopic findings of the resected stomach showed widespread coarse mucosa with multiple ulcer scar in the body, and smooth elevation on the greater curvature of the lower body. Histologic study revealed the focus of the malignant lymphoma, involving the muscularispropria. Lymphoid hyperplasia devoid of indications of malignancy coexisted in the body. Furthermore, histology of perigastric lymph nodes showed features of Hodgkin's disease, nodular sclerosis type. Postoperative chemotherapy was performed, but the patient finally died of candida infection in February 1989. This case may suggest possible malignant change in the gastric wall from RLH to malignant lymphoma.