粗大顆粒像を示したreactive lymphoreticular hyperplasiaの1例

Reactive Lymphoreticular Hyperplasia with Macroscopic Appearance of Gastric Malignancy, Report of a Case

　反応性リンパ増殖症（RLH）は，現在良性病変として広く理解されているが，実際には悪性リンパ腫との間に明確な一線を画することが困難である場合も少なくなく，これらRLHと悪性リンパ腫との連続的な関連性は，診断学的にも病理学的にも興味深いものと思われる．

　そこでわれわれは，胃悪性リンパ腫における1つの特異的所見として光島¹⁾，三坂²⁾らが報告した“溝状びらんに囲まれた粗大顆粒像”に類似した像を示すRLHの1例を提示し，若干の検討を加えた．

　We presented a case of reactive lymphoreticular hyperplasia, showing granular lesions with slight depression which is similar to the macroscopic pattern of the Ⅱc type of early gastric cancer on x-ray and endoscopic pictures. Close observation of this lesion, however, showed the unclear converging folds with moth-eaten sign, the ill-demarcated border of the lesion and the smooth surface of the granules. These findings were less frequent in the lesion of Ⅱc.

　Recently, on the other hand, we found the characteristic feature which we call as “cobblestone like appearance” on the macroscopic findings of the malignant lymphoma, especially in the superficial spreading type And the findings of such lymphoma consists of the smooth surfaced granules surrounded with sulcus like erosion. The roentgenographic or the endoscopic appearance of the case presented was similar not only to the early cancer but also to this appearance. So that, the histology of this case was reviewed carefully and repeatedly on the suspicion of malignant lymphoma. But the only massive infiltration of the small lymphocytes with swelled lymph follicles was seen in the mucosal layer, and no evidence of malignancy was detected. This case was diagnosed as reactive lmphoreticular hyperplasia (RLH). The roentgenographic and endoscopic review of this case showed that the lesion was not so extensive as those of the malignant lymphoma which dominantly showed “ cobblestone like appearance”.

　The differential diagnosis of this kind of lesion cannot be made by the findings on the tip of the converging folds or the shape of ulceration alone or both. In such a case, observation of the mucosal pattern is important, and the finding as “cobblestone like appearance” may bring us new and useful information in the diagnosis of the malignant lymphoma and its disorders.