早期潰瘍瘢痕癌に酷似した大彎部萎縮性リンパ腫様胃炎の1例

A CASE OF ATROPHIC LYMPHOBLASMATOID GASTRITIS ON THE GREATER CURVATURE CLOSELY RESEMBLING EARLY ULCER-SCAR CANCER

Ⅰ．はじめに

　早期胃癌の診断は近年長足の進歩をとげ，その症例数は急カーブに増加しており，私達巷の開業医でも発見する機会が多くなってきた．したがって早期胃癌と他の病変，特に良性病変との鑑別に充分なる注意と検査がますます必要と思われる．その鑑別すべき病変の1つにatrophic lymphoblasrnatoid gastritis，reactive lymphoreticular hyperplasiaがあり，その判別は困難を感ずることが多い．最近私達はX線検査および内視鏡検査でⅡcまたはⅡa＋Ⅱc型の早期胃癌と考えて手術し，なお切除胃の肉眼的所見からも同様に思われた症例が病理組織学的に上記reactive lymphoreticular hyperplasiaと診断された例を経験したので報告する．

　A 66-year-old housewife, having hunger pain as her chief complaint, was diagnosed as harboring a benign ulcer on the posterior wall of the corpus as well as a Ⅱc or Ⅱa+Ⅱc early cancer on the greater curvature opposite the gastric angle. The lesions in the resecterl stomach, macroscopically diagnosed as a benign ulcer and a Ⅱa+Ⅱc early cancer in the greater curvature side, were later histologically confirmed as of reactive lymphoreticular hyperplasia.

　Retrospective study of these lesions, consisting of an Ul-ulcer scar and erosions in addition to notable hyperplasia of lymphoid tissues in the lamina propria and in the submucosal layer, seem to afford a better understanding of the facts that depression visualized in the x-ray findings is more shallow as compared with that of Ⅱc, with less irregular marginal contour, together with the facts that there is rigidity in a relatively wide area with unevenness in the center of the depression as well as in its margins. It is of interest to note that, in both endoscopic findings and macroscopic observation of the resected specimen, there is no trace of engorgement, discoloration or bleeding spots in the depression, and the surface of the mucosa, looking almost the same as that of normal stomach, shows no distinct abnormal mucosal folds such as those with their tips looking as if worm-eaten. Protuberance in the surrounding area, suggesting of Ⅱa+Ⅱc, is also easier to understand when compared with its histological findings. These facts are of great account in the differential diagnosis of such lesions.

　This case would have been correctly diagnosed if gastric biopsy had been performed. Its importance has been keenly felt. This case is presented here on account of difliculty in the discrimination of a certain varieties of gastric lesions.