⑮多発Ⅱcに類似した胃悪性リンパ腫の1例

Malignant Lymphoma Simulating Multiple Ⅱc-like Advanced Carcinomas

患　者：49歳，女．

主　訴：心窩部痛．

現病歴：1973年3月頃から心窩部の不快感を覚えるようになり，5月初旬頃からは心窩部痛が増強してきた．同年5月25日に某病院で胃X線検査を受け，慢性胃炎と診断された．同年7月になっても上記症状が持続するため，ふたたび同病院を受診した．胃X線検査の結果，手術をすすめられた．同年7月30日胃癌の診断で癌研外科へ入院した．

　A 49 year-old female patient was admitted to the dep. of surgery, Cancer Institute Hospital on July 30, 1973. with the chief complaint of intermittent dyspepsia and epigastric pain before meals, which had started since March, 1973.

　The epigastric pain had been aggravated since the beginning of May, 1973. On May 25, 1973, she visited the neighboring doctor. The diagnosis of chronic gastritis was made by x-ray. Her symptoms had not been relieved until the beginning of July, 1973. Operation was recommended by that doctor immediately after the second x-ray.

　In the radiologic examination after admission the diagnosis of multiple IIc simulating advanced carcinomas was made.

　Endoscopically the lesion was suspected of malignant lymphoma because multiple mucosal depressions and nodularity were main features of the lesion. Biopsy confirmed malignant lymphoma.

　Operation was performed on August 8, 1973. Hen-egg-sized mass was palpable in the antral region of the stomach. The serosa was intact. There was no metastasis in the lymph nodes, liver, peritoneum. (N₀, H₀, P₀, S₀), and radical operation (R 3) was performed. The lesion, made up of multiple irregular depressions and nodularity in the entire antrum, measured 50×100 mm.

　Histologically the lesion was diagnosed as malignant lymphoma (diffuse, poorly differentiated, lymphocytic) which was limited to the submucosa. Multiple ulcers (Ul-Ⅱ) were associated with the lesion.