胃のReactive Lymphoreticular Hyperplasia

ON REACTIVE LYMPHORETICULAR HYPERPLASIA OF THE STOMACH

Ⅰ．はじめに

　胃腸に原発するリンパ腫は比較的予後が良好であり，その他のリンパ腫に比べて臨床病理学的にuniqueな存在であるとされていた．しかしSmith ＆ Helwig¹⁾，Faris ＆ Salzstein²⁾，Jacobs³⁾，中村⁴⁾⁵⁾らにより“reactive lymphoid hyperplasia²⁾”“pseudolymphoma³⁾”，“reactive lymphoreticular hyperplasia⁴⁾”などと呼称されているentityが胃リンパ腫に含まれていることが明らかにされた．筆者らは最近このグループに属すると思われる3例を経験し，うち2例は7年ないし4年の経過観察を行なったのでそれらを報告し，特にこの疾患と悪性リンパ腫への移行の可能性について論じてみたい．

　Lymphoma originating in the stomach was considered as a benign tumor with relatively favorable prognosis. In recent years it has been found that a pathological entity called in such various names as “reactive lymphoid hyperplasia”,“pseudolymphoma” and “reactive lymphoreticular hyperplasia” proposed by Smith＆Helwig, Faris＆Salzstein, Jacobs and Nakamura et al. is to be included in the same category.

　Three cases of this disease (63-year-old man, 47-year-old woman and 59-year-old woman) have been encountered in the authors' department. Case 1 and 2 have been followed up for 7 and 4 years respectively. Both are enjoying good health. Clinical pictures of these cases are different from those of malignant lymphoma. As for Case 3, it was endoscopically quite difficult to discriminate from Ⅱc type early gastric cancer. Histological criteria of differential diagnosis between gastric lymphoma and this pathologic entity at issue as well as malignant lymphoma, including giant follicular lymphoma, are still very much ambiguous. After due investigation, however, of 3 cases of this disease and based on detailed studies of the literature thereon, the authors are now convinced that at least a part of this disease harbors the possibility of transforming itself into malignant lymphoma.