暫時経過を追及しえた胃Reactive Lymphoreticular Hyperplasiaの1例

A Case of Reactive Lymphoreticular Hyperplasia of the Stomach Observed for Some Time

　胃のReactive lymphoreticular hyperplasia（以下RLHと省略）が，内視鏡で悪性腫瘍（早期胃癌，胃悪性リンパ腫）と紛らわしい所見を呈するというので，最近にわかに注目されるようになった．

　我が国では1966年に中村氏らが本症について報告し，その時初めてこの疾患の概念が一応確立されたといえる．最近つぎつぎに本症例が報告されているので，この疾患は今まで考えられていたほどまれなものでは無いようである．

　Reactive lymphoreticular hyperplasia of the stomach was found in a farmer 59 years of age. Recently much attention has been paid to this pathological entity because endoscopically it is apt to be mistaken for early gastric cancer. The patient had been under our medical management because of three recurring benign ulcers at the gastric angle. A wide erosive area, seen at first from the anterior wall at the level of the angle away down to the pyloric antrum, became more and more localized, finally looking like a Ⅱc lesion, so that patient was advised to undergo surgical intervention. First we incised the gastric wall to ascertain the site of the lesion, but no abnormality was found other than ulcer scars. Nevertheless, we removed about three fifths of the stomach lest any possible cancer should be overlooked.

　Histopathologically, marked lymphoreticular hyperplasia was observed in the whole area of the antrum, including the ulcer scars. The site initially suspected as Ⅱc did not correspond to that of ulcer scars, but disorderly arrangement of the muscularis muscosae as well as regeneration of the surface epithelia clearly indicated that here also an ulcer had preceded hyperplasia.

　Although it remained uncertain whether the center of reaction seen in the area of LRH corresponded to ulcer scars or to early-cancer-like area, but it can at least be presumed that changes seen in this case are due to reactive hyperplasia of lymphoreticular tissues attending on a preceding ulcer.

　One of the problems RLH of the stomach is faced with is how to differentiate it endoscopically from early gastric cancer. The present case seems to furnish us a clue to this question, because changes of the mucosal surface have been put on record in chronogical order.