初期にRLHと鑑別困難であった悪性リンパ腫の1例

A Case of Gastric Malignant Lymphoma Having Been Difficult in Differential Diagnosis with RLH in Its Early Stage

　胃疾患診断の技術の進歩はめざましいが，胃悪性リンパ腫の早期診断には困難な点が多い，1972年当時，X線検査，内視鏡検査，生検組織像からRLH（Reactive Lymphoreticular Hyperplasia）と診断され，その約1年後に諸検査の結果，悪性リンパ腫と診断された症例を経験したので提示する．

症例

　患　者：34歳　女性　会社員

　主　訴：嘔気，嘔吐

　既往歴：虫垂切除術（18歳）

　家族歴：特記すべきことなし

　現病歴：1970年頃より嘔気，嘔吐があり，数カ所の病院を受診し，諸検査を行なったが，いずれも胃に異常はないといわれた．しかし症状はその後も続き，1971年10月初め，某医受診し，入院精査の結果，早期胃癌を疑われ，1972年1月，国立がんセンター病院を紹介された．

　In spite of remarkable progress in the diagnostic techniques of gastric lesions, the diagnosis of gastric lymphoma in its early stage is still not always easy.

　Since the present author has experienced the case which was initially diagnosed as reactive lymphoreticular hyperplasia (RLH) on radiology, endoscopy and histology of gastric biopsy in 1972 and was proved to be malignant lymphoma about a year later, the case is reported.

　A 34-year-old female with complaints of nausea and vomiting was referred from other hospital where early gastric cancer was suspected on examinations.

　Initial examinations in our hospital suggested RLH. Because of no agreement for gastric resection, strict follow-up observation in the out-patient clinic was intended. However, she was hardly seen for a while. When she came in a year later complaining of fever and hunger pain, radiological and endoscopic examinations disclosed a marked progression of the gastric lesion.

　Total gastrectomy was carried out under the diagnosis of malignant lymphoma.

　A transition of RLH to malignant lymphoma remains to be settled at present; and according to Nakamura's study its frequency is quite rare.

　In careful review of biopsy material of this particular case by deeper cuttings, a minute focus suggesting malignant lymphoma was found. This suggests that malignant lymphoma had been already present one year previously.

　In this report, X-ray films at initial examination are presented and the diagnosis of gastric lymphoma especially at relatively early stage is discussed.