③Borrmann2型に類似した胃悪性リンパ腫の1例

Malignant Lymphoma Simulating Borrmann2 Type Carcinoma

患　者：48歳，男．

主　訴：心窩部痛．

現病歴：1976年1月頃から，ときどき心窩部に重圧感を覚えるようになった．同年8月頃からこの重圧感が増強しはじめ，食後に疼痛を伴うようになってきたため，同年8月26日癌研内科外来を受診した．

　A 48 year-old male patient visited the dep. of internal medicine, Cancer Institute Hospital on August 26, 1976, with the chief complaint of intermittent epigastric heaviness which had started since January, 1976. The symptom had become to be aggravated since August, 1976, sometimes being associated with epigastric pain after meals.

　In the x-ray findings a large irregular niche with surrounding raised margin was visualized at the lesser curvature of the gastric antrum. In the second x-ray after admission the lesion was considered to be unusual as carcinoma, because the surface and the outer limit of the raised margin was smooth and because the extent of the poor distensibility was changeable in a contraction phase of the antrum with simultaneous appearance of a shadow simulating submucosal tumor. However, the lesion was finally diagnosed as Borrmann 2 type carcinoma. In the endoscopic findings the lesion could not be distinguished from Borrmann 3 type carcinoma, because the raised margin which became less prominent, seemed to be covered with normal epithelium. Repeated biopsy was negative for malignancy.

　Operation was performed on October 22, 1978 under the suspected diagnosis of malignant lymphoma. At operation a hen-egg-sized mass was palpable in the antral portion of the stomach. Its serosal surface was cicatric. There was no metastasis in the lymph nodes, liver and peritoneum (N₀, H₀, P₀, S₁). Radical operation (R₃) was done. The lesion measured 55×50 mm in its extent of infiltration, showing a large irregular ulcer with rather smooth raised margin.

　Histologically, the lesion was diagnosed as malignant lymphoma (diffuse, poorly differentiated, lymphocytic). The tumor was localized mainly in the submucosa and proper muscle layer with slight involvement of the subserosa.