⑥Ⅱa＋Ⅱc型早期胃癌類似の肉眼形態を示した胃リンパ肉腫の1例

Gastric Lymphosarcoma Similar to Early Carcinoma Type Ⅱa+Ⅱc

　われわれは病巣が胃の粘膜下層までに限局し，その肉眼形態がⅡa＋Ⅱc型早期胃癌に類似していた胃のリンパ肉腫を経験したので報告する．

　症　例

　患　者：松○哲○，22歳，男，室内装飾業．

　既往歴：18歳の時，虫垂炎で虫垂切除を受け，21歳の時，腎結石で治療を受けたことがある．

　家族歴：特記すべきことなし．

　主　訴：心窩部痛．

　現病歴：1977年4月頃から軽い心窩部痛を訴えるようになり，某病院を受診し胃炎と診断され投薬を受けていた．翌5月に再び心窩部痛を生じたので某院を受診，胃X線検査で胃潰瘍を指摘され，精査のために当院を紹介されて5月18日に来院した．なお，ここ2カ月食欲がなく，体重が3kg減少した．

　We report a case of gastric lymphosarcoma which was confined to the submucosa and resembled gross findings of early carcinoma type Ⅱa+Ⅱc.

　The patient, a 22 years old man, was suffering from stomachache. X-ray studies revealed findings of early carcinoma type Ⅱa+Ⅱc and/or advanced carcinoma type Borrmann 2 located on the antrum (Fig. 1, 2). Endoscopic examination showed findings of early carcinoma type Ⅱa+Ⅱc (Fig. 3). Histopathological study of 8 specimens obtained by repeated biopsies suggested undifferentiated carcinoma or malignant lymphoma (Fig. 4). Gastric juice was normoacidic.

　Operation was performed on June 8, 1977. Subtotalgastrectomy with extended lymph node dissection was done. The lesion in the resected specimen measured 3.0×2.2 cm and localized on the antrum (Fig. 5). Histopathological study showed findings of lymphocytic and lymphoblastic mixed type lymphosarcoma and infiltration to the submucosa (Fig. 6). No metastasis was found in dissected lymph nodes.

　Postoperative progress is satisfactory with no evidence of recurrence. The present case is appeared to simulate early gastric carcinoma. It seemed to be in an early stage of lymphosarcoma which often tends to form a tumor with ulceration.