4年9ヵ月の経過観察の後，切除された胃のreactive lymphoreticular hyperplasiaの1例

Reactive Lymphoreticular Hyperplasia of the Stomach Followed Up for Four Years and Nine Months, Report of a Case

　患　者：27歳，女．

　臨床経過および検査所見　1973年5月，空腹時の心窩部痛や嘔気が生じるようになった．9月25日，虎の門病院で胃X線検査を受け，異常なしと診断された（Fig. 1a）．見なおすと，胃角前壁に楕円形のニッシェがあった．胃角部後壁の胃小区模様に異常所見はない．愁訴が持続するので，入院精査が行われた．10月30日の内視鏡検査（Fig. 4a）で，胃角小彎に類円形の浅い小さな潰瘍が2個認められた．11月6日のX線検査（Fig. 1b）および11月12日の内視鏡検査で，潰瘍が瘢痕となっていたので退院した．

　Fig. 1cは1974年9月，外来通院中に行った胃X線検査のX線像である．胃角の軽い伸展不良がある．胃角を圧迫すると，少し太まった粘膜ひだが認められた．胃角部から幽門前庭部にかけての胃小区像は，少し大きく，かつ大小不揃いで，また，小さいニッシェが多発している．

　The patient is 27 year-old woman. This case was followed up as multiple gastric ulcers by x‐ray and endoscopy from September 1973 to November 1977. It was suspected of malignant lymphoma by biopsy in November 1977. But it was diagnosed as reactive lymphoreticular hyperplasia by re-biopsy. However, because of alternation of aggravation and remission of gastric ulcer, gastrectomy was performed in June 1978.

　Macroscopically the resected stomach showed linear ulcer at the angle surrounded by discolored area, measuring 2.5×5.0 cm, and small ulcer.

　Histological diagnosis was reactive lymphoreticular hyperplasia. The site of lymphoreticular hyperplasia in the mucosa corresponded histologically to the discolored area.

　The author reviewed x-ray and endoscopic pictures about the change of lymphoreticular hyperplasia mainly. The sign of lymphoreticular hyperplasia around ulcers at the angle was not recognized clearly from September 1973 to April 1977. But x-ray and endoscopic pictures in and after September 1977 showed it obviously as findings of irregular area gastricae, localized mucosal thickness and discolored area. Therefore, lymphoreticular hyperplasia of this case was thought to be a reaction to the gastric ulcer.