多発性早期胃悪性リンパ腫の1例

Multiple Early Malignant Lymphoma of the Stomach

　多発性早期胃悪性リンパ腫の1例を経験したので報告する．

　症　例

　患　者：69歳，男，無職．

　主　訴：空腹時心窩部痛．

　既往歴：64歳のとき心筋梗塞．

　家族歴：兄姉4人，肺結核．

　現病歴：1977年10月ごろより心窩部痛，嘔気，胸やけ，噫気などを認めていたが，同年11月ごろより空腹時の心窩部痛が強くなったため近医を受診した．胃X線，内視鏡検査の結果，多発性胃潰瘍の診断を受け，1978年1月10日当科へ紹介され入院した．

　A 69 year-old man visited a neighboring doctor with a chief complaint of epigastralgia and a diagnosis of multiple stomach ulcers was made by x-ray and endoscopic examination. On January 10, 1978, he was admitted to our hospital for a complete medical evaluation.

　X-ray and endoscopic close examination of the stomach revealed four ulcerous lesions at the anterior wall of the corpus. The ear-conch-like ulcer close to the linear ulcer scar was seen at the lower portion of corpus. At the upper portion of corpus, there was a shallow irregular ulcer, which was surrounded by thin and low sharply edged marginal wall. An oval shaped ulcer and ulcer scar were observed between the two ulcer lesions. The pliability of the gastric wall was good. The diagnosis of malignant lymphoma of the stomach was made by the findings described above and confirmed by the biopsy specimen obtained from the margin of the most anal and oral ulcer lesions.

　Total gastrectomy and splenectomy were performed on February 14, 1978, and the finding at the operation was S₀P₀H₀N₀.

　Histological study of the resected stomach revealed malignant lymphoma cells (diffuse, histiocytic) limited to the mucosa and partially submucosa. The tumor cells were localized only at the part of the edge of two bipolarly existed ulcer lesions.

　We feel it important to look for multiple ulcer lesions especially ear-conch-like ulcer or ulcer scars and to obtain biopsy specimen at the margin of the ulcer for making diagnosis of early malignant lymphoma of the stomach.

　The patient is well two years and nine months after operation.