胃リンパ細網細胞増生として6年半経過をみた早期胃悪性リンパ腫の1例

Early Gastric Malignant Lymphoma Followed as Gastric Lymphoreticular Hyperplasia for Six and a Half Years, Report of a Case

要旨　症例は68歳，男性．心窩部痛，下血を主訴とし某病院を訪れ，当院を紹介された．胃X線検査，内視鏡で多発潰瘍とその瘢痕と診断，生検でGroup Ⅱ，lymphoreticular hyperplasia（LH）として6年半経過観察した．自覚症状増強するため胃3/4の摘出術を受ける．手術材料の肉眼所見で，胃体部の小彎から前後壁にかけて浅い多発潰瘍と皺襞の集中をみる．組織学的にLHと組織球型悪性リンパ腫が混在，移行する．潰瘍はUl-Ⅲ，深達度はsmの早期例である．本例からLHの悪性化が推測できた貴重な症例と考える．LHの本態は橋本病に類似する自己免疫機序による特異な局所反応性胃炎を推測した．

　A 68 year-old man, complaining of epigastralgia and melena, was referred to our hospital. He was diagnosed as having multiple gastric ulcers and scars by x-ray examination and endoscopy. Biopsy revealed lymphoreticular hyperplasia (LH). He was followedup under this diagnosis during six and a half years. but as he complained of augmentation of the subjective symptoms, he underwent 75% gastrectomy.

　Macroscopic findings of the surgical material showed superficial multiple ulcers and convergence of folds from the lesser curvature and oral region to ulcer scar.

　Histologically, mixture of LH and histiocytic malignant lymphoma was disclosed, and the degree of infiltration of the lymphoma was from the mucosa to submucosa. The ulcer was Ul‐Ⅲ.

　This is believed to be a rare case where malignant change of LH could be proved.

　The nature of LH is assumed to be specific local reactive gastritis due to autoimmune machanism, resembling Hashimoto's thyroiditis.