Reactive lymphoid hyperplasiaと併存した表層拡大型胃悪性リンパ腫の1例

Superficial Spreading Type of Malignant Lymphoma of the Stomach, Associated with Reactive Lymphoid Hyperplasia

　胃原発の悪性リンパ腫およびreactive lymphoid hyperplasia（以下RLH）は最近かなりの症例報告をみるようになったが，両者の合併例は極めてまれで，本邦では十数例を数えるにすぎない．今回表層拡大型の胃悪性リンパ腫とRLHの合併例を経験し，両者の鑑別および類似病変との鑑別上若干の知見を得たので報告する．

　症　例

　患　者：26歳，男，会社員．

　現病歴：1978年ごろより時々空腹時に締めつけられるような心窩部痛が出現し，食事により消失した．1980年5月ごろより同様症状と易疲労感が出現し北里大学病院受診．上部消化管造影で異常を指摘され，同年7月3日精査のため入院となった．

　A 26 year-old male was admitted to Kitasato University Hospital on July 3, 1980, with chief complaint of hunger pain in epigastrium. Physical examination was negative except for soft enlargement of thyroid. Laboratory data showed no remarkable change.

　On upper gastrointestinal series, multiple nodules in different sizes accompanied with irregular shallow ulcerations were demonstrated from the lower part of the gastric body to the antrum. These multiple nodules at the anal portion of the antrum became smaller and more unform than at the gastric angle. The gastric walls expanded well and the borderline between the lesions and the normal mucosa was not so clear partially. From these findings, we suspected this lesions for malignant lymphoma rather than Ⅱc-type gastric cancer radiographically.

　Biopsy specimen also revealed suspicion of malignant lymphoma, but pathologist also pointed out possibility of reactive lymphoid hyperplasia.

　Barium meal study of the small intestine showed mesenterium commune of non-rotated type and soft polypoid lesions (varices) of the third portion of the duodenum.

　Subtotal gastrectomy was performed on September 1, 1980.

　Histological examination revealed a diagnosis of malignant lymphoma of the stomach, accompanied with RLH chiefly close to its anal portion. Tumor cells infiltration limited to the mucosa and submucosal layer, and no lymph-node involvement was noticed.

　We showed the border area between malignant lymphoma and RLH microscopically, and discussed the possibility of malignant change of RLH.