多発胃reactive lymphoreticular hyperplasiaの1例

Multiple Reactive Lymphoreticular Hyperplasia of the Stomach, Report of a Case

　胃reactive lymphoreticular hyperplasia（以下，胃RLHと略す）は1928年，Konjetzny¹⁾が慢性胃炎の特殊型として記載しているが，近年，臨床診断学上，早期胃癌と鑑別困難な胃疾患の1つとして注目されている．RLHは組織学的には悪性リンパ腫との鑑別および悪性リンパ腫への移行の有無に興味が注がれ，その悪性化を肯定するようなRLHを伴った悪性リンパ腫の報告例も多くなってきた．ただし，その本態ならびに悪性化の有無についてはまた問題の多いところで，中村ら²⁾のいう限局・肥厚型で潰瘍による反応性変化とは思えない型も多く報告されるようになり，いわゆる炎症性反応像すなわち二次的変化のもののほか，benign lymphomaともいうべき腫瘍性を帯びた一次的変化のものとに分けて考えざるを得ない症例^3)～6)11)も増加してきている．

　われわれも最近，多発Ⅱcの疑いのもとに入院，内視鏡的生検組織診でRLHの疑いと診断されたが，易出血性の病変が多発し，その多彩さのため悪性病変も完全に否定できず，手術を余儀なくされた胃RLHの1例を経験し，組織学的検索で独立した14個の病変が確認された興味ある症例を報告する．

　A 42 year-old female had been suffered from epigastralgia and sense of abdominal fullness during one year.

　X-ray and endoscopic examinations of the stomach revealed many irregular-shaped depressed lesions with rough and erosive surfaces located in the oral half.

　Although it was thought initially to be multiple gastric cancer of type Ⅱc or Ⅱc+Ⅱb, she was diagnosed as having early malignant lymphoma or reactive lymphoreticular hyperplasia of the stomach at the endoscopic study of the second time.

　Biopsy was performed and its histological diagnosis was lymphoreticular hyperplasia belonging to borderline.

　The stomach totally resected showed many irregular-shaped depressed lesions located mainly in the oral half of the stomach, the surfaces of which were erosive. These lesions looked like multiple type Ⅱc of gastric cancer.

　Histological examination revealed 14 lymphoreticular hyperplasias of various size, measuring up to 7.0×4.5 cm in dimensions. Proliferations of lymphoid cells and reticulum cells are limited to the mucosa and submucosa, accompanying with plasma cells and leucocytes in the surface of the mucosa. They have no atypia. There are lymph follicles with germinal centers in the tunica muscularis mucosae and the submucosa.

　Regional lymph nodes show only slight follicular hyperplasia.