短期間に急速に変化した早期胃細網肉腫の1症例

A Case of Reticulum Cell Sarcoma of the Stomach Undergoing Changes within a Short Time

　約50日の短期間に，急速に変貌した早期胃細網肉腫の1経験例を報告する．

症　例

　患　者：I. Y.　39歳　男　農業

　既往歴：35歳，黄疸で1カ月間入院治療． 　現病歴：昭和47年10月上旬より，空腹時に心窩部痛を認めるようになった．少し痩せてきたので，11月5日に近医で内視鏡検査を受けた．胃潰瘍といわれ投薬を受けたが軽快しなかった．12月5日再内視鏡検査で，胃癌を疑われ，直ちに当院内科に入院した．

　A case of early reticulum cell sarcoma of the stomach is described that underwent remarkable changes within a short period of 50 days. A 39-year-old man noticed hunger pain in the epigastrium since about one month before. The initial endoscopy revealed a small protrusion on the anterior wall of the antrum. In one month it grew rapidly, simulating a Borrmann-type-Ⅱ neoplasm. He was admitted at once to the hospital for further workup. The verdict of biopsy on the following day was a tumor of benign nature. The gastric juice was of normal acidity. Two days before the surgical intervention the tumor was found to have undergone conspicuous change, x-ray demonstrating a shallow ulcer of irregular shape on the anterior wall of the antrum in addition to converging mucosal folds toward the ulcer. The tips of the folds showed a smooth hemispherical shape, convex toward the ulcer. They looked altogether like “the head of catfish”. As endoscopic features demonstrated on the day before the operation were the same, the tumor was clinically diagnosed as malignant lymphoma. Nonetheless, gastric biopsy on the same day judged it a benign growth. Histologically it proved to be reticulum cell sarcoma remaining within the submucosa. The tumor cells showed intramucosal invasion only in a very small part of the ulcer margin in the greater curvature side. They were also seen sparsely on the floor of Ul-Ⅱ ulcer. These findings probably account for the difficulty of diagnosis through biopsy. Some cases of malignant lymphoma of the stomach may exhibit “malignant cycle” as in gastric ulcer, showing a pattern of rapid development, breaking-down and ulceration.

　Of 12 so far reported cases of early malignant lymphoma of the stomach, biopsy was attempted in 5 and correct diagnosis was obtained in 2 (the rate of accurate diagnosis: 40%). If biopsy is performed at shorter intervals, the biopsy forceps more sharpedged, more abundant specimens taken from various spots especially aiming at the ulcer margins, and finally if histological interpretation is done more carefully, so then would the results of biopsy in early stage of malignant lymphoma surely improve