初診より2年4ヵ月経過後切除し，深達度粘膜下層であった胃悪性リンパ腫の1例

Non-Hodgkin Gastric Lymphoma with a 28 Months' Preoperative Course

　本例は初診より2年4カ月経過後に切除したにもかかわらず，深達度粘膜下層までにとどまる早期胃癌に準じた，いわゆる早期の胃non-Hodgkin悪性リンパ腫であり，年齢も比較的若年者を経験したので報告する．

症　例

　患　者：23歳，女，事務員．

　主　訴：空腹時の心窩部痛．

　既往歴：3カ月前に女児出産．

　現病歴：約2年半前より空腹時に心窩部のキリキリする痛みを覚えるようになったため，近医にて胃透視を受け胃潰瘍と診断され，内視鏡検査をすすめられるも行わず，薬の内服治療のみを続ける．その後，散発的に心窩部痛を来すも自制できるため放置していた．1ヵ月前よりとう痛がひどくなったため来院す．食欲減退，体重減少などなし．

　A 23-year-old female had complained of epigastric pain at times of hunger and upper GI series disclosed a large round ill-demarcated depressed lesion in the posterior lesser curvature of the antrum. The lesion was considered to be gastric ulcer 28 months ago. She was seen in the clinic again because of severe epigastric pain, and upper GI series disclosed wide-spread irregularly depressed lesion with irregular multiple ulcers and granular elevation from the antrum to the angle. Histologically, malignant lymphoma was strongly suspected through gastric biopsy and total gastrectomy was performed. By the resected stomach, wide-spread depressed lesion measuring 12.6×6.5 cm in size was seen in both anterior and posterior walls from the antrum to the angle. Histologically, the lesion was diagnosed as malignant lymphoma, non-Hodgkin, nodular and diffuse according to Rappaport's classification. The lymphoma was recognized only in the lamina propria and submucosal layer. It can be said that this case is early gastric lymphoma corresponding to early gastric cancer according to its limited spread of the lesion despite the long course of the disease.