MALTリンパ腫との鑑別を要した梅毒性胃腸炎の1例

Gastric Syphilis with a Colonic Lesion Pathologically Similar to Mucosa-associated Lymphoid Tissue（MALT）Lymphoma, Report of a Case

要旨●患者は30歳代，男性．X年3月より上腹部痛と水様性下痢が出現し，前医で行われたEGDで胃の潰瘍性病変を認めた．病変部の生検でMALTリンパ腫が疑われ，当院に紹介となった．全身CT，PET-CTでは頭頸部と腹腔内のリンパ節腫大が確認された．上下部消化管内視鏡検査では胃前庭部の広範な潰瘍性病変と上行結腸・横行結腸にびらんを認め，生検ではMALTリンパ腫と非特異的炎症の診断に分かれた．血清梅毒反応が陽性となり，生検組織の免疫組織化学染色にて多数のT. pallidum菌体が確認されたことから胃・大腸梅毒と診断した．MALTリンパ腫との鑑別が問題となり，胃と大腸病変を呈した消化管梅毒の症例であった．

　A man in his 30s presented with epigastric pain and watery diarrhea. Endoscopic examination performed by the clinic showed multiple gastric ulcers. The lesion was diagnosed as a mucosa-associated lymphoid tissue lymphoma based on histopathological examination of the biopsy specimen. Computed tomography and positron emission tomography-computed tomography revealed the swelling of lymph nodes in the patient's head and neck. Endoscopic examination showed shallow ulcers at the antrum of the stomach, as well as multiple erosions of the ascending colon and transverse colon. Pathological examination of repeated biopsied specimens could not differentiate mucosa-associated lymphoid tissue lymphoma from nonspecific inflammation. Additional serological testing for syphilis was positive, and immunohistochemical examination for Treponema pallidum revealed infiltration of T. pallidum in biopsy specimens from the stomach and colon. Based on serological examination and pathological immunoassay, the patient was diagnosed with gastric and colonic syphilis and syphilis eradication therapy was performed. The patient achieved complete remission and remains in good condition with no evidence of recurrence.