巨大な隆起型と早期胃癌（0-IIc）類似型病変が混在した胃MALTリンパ腫の1例

MALT Lymphoma of the Stomach Composed of Large Protruding Type and Early Gastric Cancer（Type 0-IIc）-like Type Lesions, Report of a Case

要旨●患者は78歳，男性．主訴は胃部不快感．近医での胃X線造影検査にて胃粘膜下腫瘍を疑われ，当院を紹介され受診となった．上部消化管内視鏡検査にて，胃体中下部大彎に50mm大の発赤調の粗大顆粒状粘膜に覆われた粘膜下腫瘍様の半球状隆起性病変と，その肛門側に，同様に発赤顆粒状を呈した陥凹性病変を認めた．生検でMALTリンパ腫と診断され，全身精査にてLugano国際分類I期と診断した．血清抗体法でH. pylori陽性であり，一次治療として除菌療法を行った．3か月後にはいったん腫瘍の縮小を認めたが，除菌から半年後には再増大を認め，除菌抵抗性と判断し，二次治療として放射線療法を行った．放射線療法1年後には，胃病変の消失を認め，現在まで無再発生存中である．胃MALTリンパ腫の肉眼所見は，多彩であることが特徴であるが，本症例は粘膜下腫瘍様の大きな隆起所見と早期胃癌（0-IIc）類似の陥凹所見が併存した，まれな症例であると思われた．

　A 78-year-old male was referred to our hospital for further examination of a gastric SMT（submucosal tumor）-like lesion. Endoscopy revealed a SMT-like elevated lesion, which was 5cm in size and covered by reddish, rough, and large granulated mucosa, and a depressed lesion, the surface of which was similar to the elevated lesion. These lesions were diagnosed as MALT（mucosa-associated lymphoid tissue）lymphoma by biopsy, and the clinical stage was identified as Stage I（Lugano International Classification）. Because he was positive for Helicobacter pylori infection, we performed H. pylori eradication therapy. Three months later, gastric lesions had decreased in size；however, six months later following the eradication therapy, the lesions had increased in size again. Because the infection was considered to be antibiotic-resistant, we performed radiation therapy. One year later following radiation therapy, the gastric lesions completely disappeared, and there has been no recurrence since. Various macroscopic findings are a feature of MALT lymphoma of the stomach. This was a rare case because of the coexistence of the large SMT-like elevated lesion and the early gastric cancer（Type 0-IIc）-like depressed lesion.