⑫巨大皺襞形成がみられた胃悪性リンパ腫の1例

Malignant Lymphoma Showing Giant Rugal Pattern

患　者：61歳，男．

主　訴：心窩部重圧感．

現病歴：1967年5月の初めから心窩部重圧感があり，また，飲酒後に心窩部痛を覚えるようになった．同年5月5日某医院で胃X線検査を受け胃潰瘍と診断された．内科的治療がはじめられたが同年11月同医のもとで2回目の胃X線検査を受け，手術をすすめられた．同年ll月13目胃癌の診断で癌研外科へ入院した．

　A 61 year-old male patient was admitted to the dep. of surgery, Cancer Institute Hospital on No-vember 13, 1967, with the chief complaint of epigastric heaviness and pain after taking alcohol which had started since the beginning of May, 1967.

　On May 5, 1967, he was examined with x-ray by the neighboring doctor, and the diagnosis of peptic ulcer was made. Medical treatment had been continued until the beginning of November, 1967, when the second x-ray examination suggested the necessity of operation.

　On the x-ray and endoscopic examination after admission, the diagnosis of linitis plastica type carcinoma was made. Biopsy was negative for malignancy. Operation was performed on November 28, 1967.

　At operation no mass was palpable in the stomach. Serosal surface presented tendon-like hardness. There were lymph nodes metastases at the root of the mesentery and the paraaortic region. Total gastrectomy with combined resection of the tail of the pancreas and spleen was done (N₃, H₀, P₀, S₁), resulting in relative curative operation.

　The operated stomach revealed edematous enlargement of the mucosal folds from the fornix to the gastric angle and slight depression of the angular region, showing the fine granularity. There was a shallow ulcer on the anterior wall of the gastric body. Histologically the lesion was diagnosed as malignant lymphoma (nodular, well differentiated, lymphocytic) involving almost upper two thirds of the stomach, measuring about 180×160 mm. The infiltration of the tumor involved the proper muscle layer. All dissected nodes were positive.