いわゆるReactive Lymphoreticular Hyperplasiaと鑑別困難であった胃悪性リンパ腫の1例

Malignant Lymphoma of the Stomach Hard to Differentiate from the S0-called Reactive Lymphoreticular Hyperplasia, Report of a Case

　近年，胃原発性悪性リンパ腫は数多く報告され，早期の胃悪性リンパ腫も散見されるようになった．またいわゆる胃のreactive lymphoreticular hyperplasia（以下いわゆるRLHと略す）も報告が増し，悪性リンパ腫との胃X線，内視鏡での鑑別診断や病理組織学的な鑑別診断が諸家によりなされているが，未だ暗中模索の段階である．さらに術前，いわゆるRLHの診断で経過観察中に急激な変化を呈した胃悪性リンパ腫の報告も自験例を含め少数ながらみられる．私共は確定診断ができないままに，1年間の経過観察の後に検査所見の推移も合わせて，悪性リンパ腫を疑診し手術したところ，病理組織学的に一部に明らかな悪性リンパ腫と診断しうる1症例を経験したので報告する．

　The so-called reactive lymphoreticular hyperplasia (RLH) of the stomach as revealed by x-ray and endoscopy was found in a woman aged 53. After one year of follow-up she underwent gastric resection. We found histologically malignant lymphoma in a part of findings similar to RLH, which could not be regarded as an extensively malignant lesion.

　Her chief complaint was hunger pain in the gastric pit. Laboratory examination showed no abnormality other than slight anemia, hypoproteinemia. The feces was positive for occult blood.

　The initial examinations by x-ray and endoscopy showed only a slight deformity of the greater curvature of the lower body accompanied with several small irregular barium flecks. As biopsy revealed no abnormality, the patient was placed under observation. Eleven months later the lesion became worse, extensive and more variegated. After one month multiple erosions and ulcers on the greater curvature of the body became less severe, while the mucosa around them showed rounded granular shadows of various size. Furthermore, there appeared newly shallow irregular depressions on the lesser curvature of the mid-body up to the upper part of the body. It might be more usual to diagnose the above-mentioned histologic findings as those of malignant lymphoma on the whole, but we believe it would be impossible to rule out malignant transformation of the so-called RLH. Macroscopically it was very difficult to differentiate malignant lymphoma from multiple erosive and uicerous type of RLH. The present case has given us some questions about its diagnosis and themost appropriate time for surgical removal.