胃DLBCLの診断と治療―診断

Diagnosis and Treatment of Primary Gastric Diffuse Large B-cell Lymphoma : Diagnosis

当院で経験した胃原発DLBCL（diffuse large B-cell lymphoma）14症例の肉眼型を，表層拡大型，巨大皺襞型，腫瘤形成型の3型に分類し，病変の分布，内視鏡所見，超音波内視鏡所見との関係について検討した．肉眼型は腫瘤形成型が最も多く，（1）壁の伸展性が保たれ，（2）粘膜下腫瘍の要素がみられ，（3）潰瘍を伴う病変では幅の狭い耳介様周堤と陥凹内に厚い白苔を伴い，（4）病変の多発など，多彩な所見を呈し，（5）EUSで均一な低エコー腫瘤として描出される所見は，DLBCLを疑う所見であった．胃DLBCLは所見が多彩であり，発育進展様式を十分に考慮したうえで柔軟な診断を行っていくことが重要であると考えられた．

　We classified 14 cases of gastric DLBCL（diffuse large B-cell lymphoma）into 3categories on the basis of macroscopic findings（superficially spreading type, giant fold type, and mass-forming type）, and analyzed the distribution, endoscopic findings, and ultrasonoscopic endoscopic findings. Eight patients had the mass-forming type of lesions, 4 patients had the superficially spreading type, and 2 patients had the giant fold type lesions. Endoscopic findings were as follows :（1）the extension of the gastric wall was retained,（2）sub mucosal tumor-like lesions were present,（3）narrow auricle-like embankments and thick-furred ulcer base（with ulcer forming lesions）,（4）multiple lesions, and（5）uniform low-echoic mass on endoscopic ultrasonoscopy. To diagnosis gastric DLBCL, clinicians should understand intricacies of its tumor growth and invasion, and its histopathological features because endoscopic findings widely vary.