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Stomach and Intestine(Tokyo) Volume 28, Issue 10 （September 1993）

胃と腸 28巻10号（1993年9月発行）

Japanese English

今月の主題胃悪性リンパ腫―診断の変遷

主題症例

表層拡大型進展を示した胃MALTリンパ腫の1例 Mucosa-Associated Lymphoid Tissue (MALT)-Type Malignant Lymphoma of the Stomach, Report of a Case 青崎真一郎 ^1,3 , 濵田富志夫 ¹ , 馬場泰忠 ¹ , 野村覚 ² , 萩原一行 ² , 松野浩一 ³ , 唐仁原寛 ³ , 丸田修士 ³ , 西俣寛人 ³ , 有馬暉勝 ³ , 蓮井和久 ⁴ Shin-ichiro Aozaki ^1,3 , Kazuyuki Hagihara ² , Kouichi Matsuno ³ , Kazuhisa Hasui ⁴ ¹済生会川内病院内科 ²済生会川内病院外科 ³鹿児島大学医学部第2内科 ⁴鹿児島大学医学部第2病理 ¹Department of Internal Medicine, Saiseikai Sendai Hospital ²Department of Surgery, Saiseikai Sendai Hospital ³The Second Department of lnternal Medicine, Faculty of Medicine, Kagoshima University ⁴The Second Department of Pathology, Faculty of Medicine, Kagoshima University キーワード：胃悪性リンパ腫 , MALTリンパ腫 , RLH , 低悪性度B細胞性リンパ腫 Keyword: 胃悪性リンパ腫 , MALTリンパ腫 , RLH , 低悪性度B細胞性リンパ腫 pp.1115-1123

発行日 1993年9月25日 Published Date 1993/9/25

DOI https://doi.org/10.11477/mf.1403106271

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Abstract 文献概要
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要旨　患者は72歳，女性．自覚症状はないが人間ドックの胃X線検査で，体上部および胃角部の小隆起性病変を指摘され，内視鏡検査を施行．生検にてB細胞性低悪性度リンパ腫と診断された．X線および内視鏡による精査では病変は胃全体に拡がっており，胃全摘術が施行された．手術標本の組織学的検索では，主として粘膜層内に広範囲に浸潤するMALT（mucosa-assoclated lymphoid tissue）リンパ腫と診断された．本症例のX線像，内視鏡像および病理組織像を呈示した．

　Endoscopic examination was carried out in a 72-year-old female for small elevated lesions in the upper body and angular region of her stomach which were indicated by medical checkup-gastric roentgenography. She had no subjective symptom. Low-grade malignant B-cell lymphoma of the stomach was diagnosed from the histology of the biopsied specimens.

　The detailed x-ray examination showed abnormal areae gastricae extending to the whole stomach. The abnormality of areae gastricae contained irregularity in size and form, and disorders of direction and arrangement. Sulcus-like erosions surrounding the individual areae gastricae were sporadically observed. Endoscopic examination showed unevenness of the mucosa distributing on the whole stomach. The mucosa was composed of variously sized and smooth-surfaced granules with sporadically distributed sulcus-like erosions which was revealed by dye spraying method.

　We then diagnosed as gastric malignant lymphoma of superficial spreading type. Total gastrectomy was subsequently performed for the patient.

　Examination of the whole stomach resected in the serial sections showed that malignant lymphoma (ML) cells revealed infiltrative proliferation with sporadic or diffuse growth pattern in the mucosa of the whole stomach and involved focally the submucosal layer. No metastasis of the ML was seen in the regional lymph nodes examined. The ML cells were small lymphocytic, comprising cytologically so-called centrocytoid cells, monocytoid cells and plasmacytoid cells. These ML cells formed lymphoepithelial lesions in the mucosa. Paraffin-immunohistochemically the ML cells were B cells and revealed differentiation to plasma cells having monoclonal cytoplasmic immunoglobulin. Thus, this case was diagnosed as mucosa-associated lymphoid tissue (MALT)-type malignant lymphoma involving almost whole mucosa of the stomach.