胃生検で診断しえ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 Diagnosed with Biopsy, Report of a Case

　胃原発悪性リンパ腫，なかでも表層拡大型胃悪性リンパ腫と，いわゆるreactive lymphoreticular hyperplasia（以下RLHと略す）との胃X線および内視鏡による鑑別診断は種々試みられているが，いまだ困難である．われわれは4カ月の経過観察中に多発する潰瘍やびらんが治癒傾向を示したが，2回にわたる生検により確診しえた表層拡大型胃悪性リンパ腫の1例を経験したので報告する．

　The patient, a 30-year-old woman, visited our hospital because of persistent epigastric and back pain of two years' duration. Physical examination and study of the urine, feces and blood were normal. On the other hand, x-ray examination of the stomach showed multiple irregularly-shaped ulcers and erosions from the angle down to the antrum. The mucosal surface around them was granular, either fine or rough. The areas between each granula showed relatively distinct grooves. The border between them and the normal mucosa was not clear. Endoscopy also revealed multiple ulcers of irregular shape and erosions. The lesion as a whole was edematous. These findings led us to suspect malignant lymphoma or reactive lymphoreticular hyperplasia. During the four months' follow-up ulcers and erosions were cured or became better. Gastric biopsy twice revealed histologic findings of malignant lymphoma, so that subtotal gastrectomy was performed. The postoperative course was uneventful. Resected specimen of the stomach showed macroscopically finely- or coarsely-granular mucosal surface, extending from the angle down to the pyloric antrum. The border between the lesion and the normal mucosa was again not clear. Two ulcers were seen at the angle within the lesion. These findings obviously differed from those of Ⅱc type early cancer. Histologically the lesion was malignant lymphoma of diffuse histiocytic type. Tumor cells invaded only the mucosa and submucosa. The lesion showed skipping, or discontinuity.