胃形質細胞腫の1例

Plasmacytoma of the Stomach, Report of a Case

要旨　患者は55歳女性で心窩部痛を主訴とし，Borrmann4型胃癌の診断で当科を紹介された．入院時検査では貧血以外特に異常は認められず，胃全摘術，膵脾合併切除術が施行された．術後組織学的検討にて形質細胞腫が疑われ，組織酵素抗体法を施行したところIgG一κ型の軽鎖を産生する形質細胞腫と診断された．腫瘍細胞内免疫グロブリンが証明された症例は現在まで欧米例を含め14例あるがIgG型が7例，IgA型が7例と多発性骨髄腫に比べIgA型の発生頻度が高い．これは消化管に分泌性IgAが多いことと一致し興味深い．また，病勢に伴い血清中にM蛋白，免疫グロブリン異常が認められた症例が本邦例18例中8例あり，これらが病勢の指標となりうる可能性が示唆された．

　Radiologic and endoscopic examination of a 55 year-old woman complaining of epigastralgia led to a diagnosis of gastric cancer of Borrmann type 4. Preoperative laboratory studies showed no abnomalities but anemia. Total gastrectolny with distal pancreaticosplenectomy was performed. The pathology report suspected that this was a case of gastric plasmacytoma. The tumor cells were shown, by the immunoperoxidase technique, to contain IgG and kappa type light chain.

　Eight of 18 cases with gastric plasmacytoma collected in Japanese literature on the subject showed a rise of immunoglobulin level or M-protein in sera of patients with progression of the disease. This fact indicates that the serum immunoglobulin and/or Mprotein may be a marker of this disease.