悪性リンパ腫様の形態を呈した良性潰瘍例

A Benign Ulcer with a Malignant Lymphoma-like Morphology of the Stomach, Report of a Case

要旨●患者は70歳代，男性．心窩部不快感で前医を受診し，上部消化管内視鏡検査（EGD）を施行したところ胃穹窿部に潰瘍性病変を認め，精査加療目的に当院に紹介され受診となった．当院のEGDでは胃穹窿部大彎に25mm程度の辺縁隆起を伴う潰瘍性病変を認めた．潰瘍辺縁は整で，蚕食像は認めず，脱気で変形する比較的軟らかい病変であり，悪性リンパ腫と診断した．生検結果は良性潰瘍の診断で，悪性リンパ腫の所見は認めなかった．腫瘍を疑う所見は認めず，良性潰瘍との診断であった．以後は約6か月ごとに経過観察の上部内視鏡検査を施行し，年に1回は生検を施行しているが，現在まで，病理結果はすべて良性潰瘍の診断である．

　A 74-year-old male was referred to our hospital for the evaluation and treatment of a gastric ulcer. Esophagogastroduodenoscopy identified a 25mm, ulcerated lesion with a slight surrounding elevation at the greater curvature of the fornix. Chromoendoscopy revealed that the edge of the lesion had a clear margin and no encroachment. The lesion was diagnosed as being a malignant lymphoma. The evaluation of the biopsy specimen revealed a benign ulcer. Periodic endoscopic follow-up was performed approximately every 6 months with oral treatment using PPIs. To reconfirm the initial diagnosis, periodic biopsy specimens were obtained each year from the lesion, which also confirmed the findings of a benign ulcer.