早期胃悪性リンパ腫の1例

Early Stage Malignant Lymphoma of the Stomach, Report of a Case

要旨　患者は46歳，男性．定期検診の目的で近医を受診し，内視鏡下生検の結果，胃悪性リンパ腫と診断され本院に紹介された．入院後，内視鏡，胃X線検査で経過観察中，病変の一部と思われる潰瘍が著明に縮小し，耳殻状隆起が目立ってきた．生検結果と臨床経過より胃悪性リンパ腫と診断，手術を施行した．病理組織検索では，耳殻状隆起上のみに腫瘍細胞が認められ，病変の一部は脱落した，と推察された．深達度smのlarge cell typeのmalignant lymphomaであった．リンパ節転移，脈管侵襲は認められなかった．

　A 46 year-old man was referred to our hospital for surgical treatment of malignant lymphoma of the stomach. This diagnosis had been made by the referring physician based on the biopsy findings of ulcer margin (Fig. 1, 2 a, 2 b) . During the hospitalization radiological examinations were performed as well as endoscopic examinations twice each (Fig. 3～6).

　In the course of observation, an irregular ulceration on the anterior wall of the angulus has markedly diminished in size (Fig. 6), while an ear-lobe shaped, elevated lesion had become clearly detected in 18 days.

　The diagnosis of malignant lymphoma of the stomach was made based on these biopsy findings and clinical course.

　Gastric resection was performed. A shallow depression with converging folds (Fig. 7) and the ear-lobe shaped, elevated lesion on its greater curvature side (Fig. 8 a) were observed macroscopically in the resected specimen.

　Histologically, infiltration of malignant lymphoma was limited to the submucosa (Fig. 8 b, c) and regional lymph nodes were free from invasion.

　Although there have been several reports on the maked changed in appearances of early malignant lymphoma of the stomach in a relatively short period of time, our present case, seemingly the most typical one, highly suggests the existence of such a “malignant cycle” in early malignant lymphoma as that seen in early gastric cancer.