Borrmann 2型進行癌と鑑別が困難であった胃悪性リンパ腫の1例

Malignant Lymphoma Simulating Borrmann 2 Type Carcinoma

　われわれはBorrmann 2型進行癌と鑑別が困難であった胃悪性リンパ腫の1例を経験したので報告する．

　症　例

　患　者：20歳，女．

　主　訴：上腹部重圧感および食欲不振．

　現病歴：約2カ月前より，食後の上腹部重圧感および食欲不振あり，外来受診す．胃X線および内視鏡検査にて幽門前庭部の悪性病変を疑われ入院となる．

　A 20 year-old female patient was admitted to our hospital with complaints of epigastric heaviness and anorexia which had appeared since two months ago.

　In laboratory findings, her feces was positive for occult blood.

　In the x-ray findings, a large irregular niche with surrounding elevated margin was noted at the gastric antrum. In the upright compression film, the outer margin of the surrounding translucency seemed more smooth than the inner margin (submucosal origin ?). Endoscopic picture demonstrated whitish to yellowish exsudate in the ulcer-base and the surrounding mucoral elevation in the anterior wall of the antrum. In the x-ray and endoscopic findings, the lesion was considered as Borrmann 2 type carcinoma.

　Resected stomach revealed an irregular ulceration with the surrounding mucosal elevation with a size of 25×20 mm at the anterior wall of the antrum. A bridging fold was observed on the surrounding elevated mucosal of the lesion.

　Histologically, the lesion was diagnosed as malignant lymphoma (diffuse, poorly differentiated, lymphocytic). The tumor was localized in the submucosa of the resected stomach. However, systemic metastases to lymph nodes in various parts in the body appeared two years and eight months after the gastrectomy.