⑬表層拡大型胃悪性リンパ腫の1例

Superficial Spreading Type of Malignant Lymphoma of the Stomach

患　者：永○秀○（O-452）42歳，男，会社員．

家族歴：特記事項なし．

既往歴：39歳時，胃潰瘍の診断で内科治療．

現病歴：3ヵ月前より軽度の空腹時心窩部痛があり，会社胃集検に際し，間接X線所見の胃角変形，辺縁不整および同部のバリウム付着異常によりチェックされ精密検査にまわった．現症：栄養良好，貧血なく，表在リンパ節を触知しない．腹部に腫瘤なく腹水貯溜を認めない．

　A 42 year-old man came to the clinic for a close examination of the abnormality checked in a gastric mass survey. The x-ray examination of the stomach revealed the lesion within multiple irregularly-shaped shallow ulceration along the lesser curvature from the upper part of the gastric angle to the angular portion and on the posterior wall. The outline of these slightly depressed lesions are less sharp and the niveau difference at the margin are not clear.

　By gastroscopic examination, we were able to check clearly multiple ulcerations surrounded by rough and edematous mucosa and blurred blood on the margin of the ulcers.

　The diagnosis of malignant lymphoma was confirmed by biopsy and its operation was performed.

　Pathological findings show the irregularly-shaped shallow depression with converging folds on the angular portion toward anterior wall and slightly depressed lesion on the posterior wall resembling Ⅱc-type of early gastric cancer, but these depressed lesions have neither sharp outline nor clear niveau difference except on the anal side of the margin. Yet multiple ulcerous lesions were seen in these slightly depressed lesions.

　Microscopical examination of the resected specimen revealed diffuse and massive tumor cell infiltration limited to the mucosal and submucosal layer. The pathological diagnosis was poorly differentiated lymphocytic lymphoma.