短期間に著明に自然縮小した胃原発悪性リンパ腫の1例

Early Malignant Lymphoma of the Stomach with Spontaneous Regression of the Tumor : Report of a case

要旨　患者は40歳，女性．空腹時心窩部痛を主訴に来院し，初診時のX線，内視鏡検査で胃前庭部大彎に平皿状の腫瘍を認め，生検診断とも併せて悪性リンパ腫と診断された．初診より40日後の内視鏡検査で腫瘍は著明に縮小し，65日後の胃切除標本では，病変は肉眼的には治癒期の消化性潰瘍のごとくであった．組織学的にはUl-Ⅱの潰瘍底の肉芽組織の中に径2mmの悪性リンパ腫の微小病巣を認めた．本例は潰瘍化を契機に自然縮小し，腫瘍がほとんど消失に近い状態まで至ったまれな症例と考えられた．

　A 40 year-old woman visited our hospital in March 1983 complaining of epigastric pain before meals. Initial x-ray and endoscopic examination revealed a large protuberant tumor with shallow saucer-like ulceration on the greater curvature of the pyloric antrum. The diagnosis of malignant lymphoma was made for this lesion, which was confirmed by histologic diagnosis of the biopsy specimen.

　About 40 days after initial examination, remarkable regression of the tumor without any radiation or chemotheraphy was observed on gastroscopy. Further decrease in the size of the tumor resulted in a small ulcer with mildly elevated surrounding margin that was mimicking benign peptic ulcer in healing stage.

　Despite remarkable diminishment of the tumor, operative therapeutic procedure was employed because review of the initial x-ray and endoscopic examination with histologic examination of the biopsy specimen highly suggested that this lesion was still a malignant lymphoma. Pathologic examination of the resected specimen showed small shallow ulcer on the greater curvature of the pyloric antrum. Microscopically, a small focus of malignant lymphoma, 2 mm in diameter, was found in the granulation tissue of the ulcer base (Ul-Ⅱ). Together with the initial biopsy specimen, histologic diagnosis of diffuse, medium-sized cell type malignant lymphoma was made.

　Although there have been several case reports of early malignant lymphoma with remarkable morphologic change, this case seems to be the most prominent one, suggesting the possibility of spontaneous regression or cure of early gastric malignant lymphoma.