扁桃悪性リンパ腫に引き続いて発生した胃悪性リンパ腫の1例

Malignant Lymphoma of the Stomach with Prior Involvement of Tonsil

　最近われわれは，扁桃悪性リンパ腫に続いて発生した胃悪性リンパ腫を経験したので報告し，合わせて21例の胃悪性リンパ腫手術症例における他部位の悪性リンパ腫の既往を検討する．

症　例

　患　者：58歳，男，会社員．

　主　訴：心窩部痛．

　現病歴：生来健康であったが，1978年6月咽頭痛を主訴として当院耳鼻咽喉科を受診し，右口蓋扁桃悪性リンパ腫の診断のもとに1,200radの⁶⁰Co照射を受けた．1979年2月中旬より心窩部痛が出現するようになったために，3月初旬，同放射線科を受診した．胃X線，内視鏡，生検などの諸検査の結果，胃悪性リンパ腫と診断され，3月16日から4月5日にかけて総線量3,000radの⁶⁰Co照射を受けたのち，4月22日当科に入院した．

　A 58-year-old man visited Tokyo University Hospital in March 1979 complaining of severe abdominal pain. He had a past history of malignant lymphoma of right tonsil six months before to which was ⁶⁰Co irradiated (1,200 rad in total). X-ray and endoscopic examinations and biopsy materials gave sufficient data for the diagnosis of malignant lymphoma of the stomach. On May 8, 1979, distal gastrectomy was performed after irradiation of ⁶⁰Co (3,000 rad). Resected stomach showed 7×7.5 cm sized ulcer on the greater curvature of antrum. Histological findings were of immunoblastic type malignant lymphoma.

　During the past 20 years, we experienced 21 malignant lymphomas of stomach, all of which were resected in our department. Six cases developed six months to 12 years after an initial diagnosis of malignant lymphoma of head or neck. In one patient, malignant lymphoma of ileum was found after five years as the 3rd involvements. Six patients were four males and two females and all the original, second and third tumors were histologically of the immunoblastic type.

　The interesting association of stomach lymphomas and those of head or neck remains unexplained but does not appear to be associated with dissemination and/or metastasis from (1) the long interval between the initial diagnosis of head and neck lymphomas and subsequent developement of stomach tumors and long survival periods, (2) little anatomical relationship between these two sites and (3) macroscopic findings of stomach tumors suggesting their primaries.