胃原発性細網肉腫の1例

A Case of Primary Malignant Lymphoma of the Stomach

　胃悪性リンパ腫は肉眼形態の多彩性で知られているが，一般には潰瘍形成を伴なった症例の報告が多い．筆者らは，腫瘍の浸潤が筋層に及ばず，粘膜下層を中心に粘膜固有層に拡がり，肉眼的には潰瘍形成を伴なわない多発性隆起性病変を呈した胃細網肉腫の1例を経験したので報告する．

Ⅰ．症例

　患　者：岩○幸○　63歳　男

　主　訴：腹部膨満感．

　病　歴：生来著患を知らないが，昭和45年8月頃より腹部膨満感を訴えるようになり受診した，前病歴，家族歴には特記すべき事項はない．貧血（－）．るいそう（－）．

　The purpose of this paper is to report a case of primary malignant lymphoma of the stomach showing various configurations of multiple polypoid lesions without ulceration. Its invasive growth patterns were analized and briefly discussed.

　A 63-year-old male admitted with a complaint of epigastric fullness for one month's duration. Gastrointestinal series disclosed multiple polypoid lesions of the stomach. Most of them were seen to have submucosal-tumor-like nature by gastroscopic study. According to the histological examination, biopsy specimens obtained from the lesions were thought to be group V, carcinoma simplex or malignant lymphoma. Surgical treatment was recommended and gastrectomy was performed. Histological study of the resected stomach revealed multiple polypoid lesions composed of malignant lymphoma (reticulum cell sarcoma). Infiltration of the sarcoma cells was limited within the mucosa and submucosa with metastasis to the regional lymph nodes. Its invasive growth patterns were analyzed and divided into three basic types, i.e., 1) submucosal tumor type, 2) superficial spreading type, and 3) sclerosing mucosal fold type. In the last type, the sclerosing mucosal folds were thought to be associated with reactive lymphoreticular hyperplasia combined with proliferation of collagen fibers. The combination of these types was thought to show the various configurations of the multiple polypoid lesions of the stomach.