胃生検で確診したReactive lymphoreticular hyperplasiaの1例

Reactive Lymphoreticular Hyperplasia (RLH) of the Stomach Accurately Diagnosed by Biopsy, a Case Report

患　者：天○九○　66歳　男

現病歴：昭和46年3月より上腹部痛を覚え，某医を受診し胃X線および内視鏡検査で早期癌を疑われ，46年4月国立札幌病院消化器科に入院した．

　A case of reactive lymphoreticular hyperplasia of the stomach is described, preoperatively diagnosed as such and later confirmed in the resected specimens, with a discussion on the effectiveness of gastric biopsy and some of its problems at issue.

　A 66-year-old man was admitted to the Sapporo National Hospital as elsewhere he had been suspected of harboring early gastric cancer. He had felt pain in the epigastrium then.

　Roentgenography of the barium-filled stomach revealed widening of the angle along with decreased distensiblity of the antrum and rigidity of the wall. In supine double contrast study granular shadows of uneven size and erosions at the angle were depicted together with rugal convergency on the posterior wall at the level of the angle. A notched shadow was seen as well on the greater curvature of the antrum. Endoscopy disclosed four mucosal folds converging toward an area above the angle. They became confluent and ceased on the way. A pale white coat and granules were observed at the angle. From here to the anterior wall of the antrum and over to the greater curvature was seen a well-circumscribed, thin linear white coat in conjunction with bleeding spots. The lesion on the greater curvature side suggested Ⅱc. Biopsy was attempted twice under a tentative diagnosis of atypical Ⅱc, and 27 specimens were collected altogether. The diagnosis was RLH, confirmed as such in the resected stomach.