⑪多彩な肉眼形態と短期間（2カ月）の間に病巣の増大を来した胃悪性リンパ腫の1例

Malignant Lymphoma Showing Marked Alter-ations of the Lesion in a Short Period

患　者：56歳，男．

主　訴：嘔気および食思不振．

現病歴：1975年11月頃から時々黒色便に気づいていたがそのまま放置していた．その後，1977年6月までに約12kgの体重減少があり，この頃から嘔気および食思不振を覚えるようになった．6月中旬に某医を受診し，胃X線検査を受けたが異常所見は指摘されなかった．しかし9月になっても上記症状が改善しないため，9月28日癌研内科を受診した．

　A 56 year-old male patient visited the dep. of internal medicine, Cancer Institute Hospital on September 28, 1977 with the chief complaint of weight loss and anorexia.

　The x-ray (Sep. 28, 1977) and endoscopic findings (Oct. 15, 1977) after admission were sufficient enough to make the diagnosis of malignant lymphoma. The biopsy proved the diagnosis. The second x-ray (Nov. 11, 1977) performed 60 days after the first x-ray revealed marked alterations of the lesions.

　At operation (Nov. 25, 1977) multiple hard masses were palpable in the entire stomach. Serosal surface was normal. There was extensive lymph nodes metastases at the root of the mesentery and posterior pancreatic region. The liver and peritoneum were free from metastases. Palliative operation (N₃, H₀, P₀, S₀) was done. The resected stomach revealed irregular thickening of the mucosal folds of the posterior wall from the upper to the lower body. Two mucosal protuberances with surface depression and the converging folds were at the posterior wall of the angular region and the anterior wall of the lower body. Another small protuberances were seen between them (Fig. 7).

　Histological examination revealed malignant lymphoma (diffuse, mixed cell type) involving the subserosa. Those three mucosal protuberances were considered to be the foci of intragastric metastases. It was incidentally revealed that there were four more small foci of intragastric metastases which were unrecognizable macroscopically (Fig. 7).