胃形質細胞腫の1例

A Case of Gastric Plasmacytoma

　骨および骨髄以外の軟部組織に原発する形質細胞腫は髄外性形質細胞腫と呼ばれ，大部分は上気道，口腔，結膜にみられ，消化管原発はまれで約10％といわれている．胃形質細胞腫はVasiliu¹⁾が1928年第1例を報告して以来今日まで欧米では50例を越え，本邦でも12例の報告^2～12)がみられる．われわれは術前に進行癌を疑い，病理組織学的検索にて，胃形質細胞腫と診断した本邦第13例目の症例を経験したので若干の文献的考察を加え報告する．

　Primary plasmacytoma of the stomach is a rare entity. This is a report of one additional case, a 78-year-old woman who seems to be the 13th case in this country. Preoperative diagnosis by Ba-meal examination and endoscopy was Borr. 2 type of advanced gastric carcinoma. Retrospectively, lack of attention to the plasmacytes in the biopsy specimen led us to this false diagnosis. Postoperative diagnosis on the fundectomied stomach appeared to be plasmacytoma histopathologically. No metastases to regional lymph nodes were found. The tumor was partly nodular but almost ulcerative on the esophago-cardiac junction, and was limited within the submucosal layer. In a part, the tumor was also beneath the esophageal mucosa. During the period of hospitalization and follow-up, no evidence of generalized multiple myeloma was found. The patient is alive and well after one year and a half.

　No case of esophageal plasmacytoma has yet been reported. Our case, however, showed some amount of infiltration to the esophageal submucosal layer. As described in the literature, almost all of the preoperative diagnoses were gastric carcinomas, and only a few cases appeared to be plasmacytoma in the biopsy specimens. Therefore, we have not only to interpret the biopsy specimens whether it is carcinoma or not, but also to pay attention to this kind of entity henceforth. Because systemic disease ulti-mately develops in many patients with localized plasmacytoma, such patients should be followed closely for the appearance of clinical, biochemical, roentgenologic evidence of multiple myeloma.