短期間に自然消失した胃diffuse large B-cell lymphomaの1例

Diffuse Large B-cell Lymphoma of the Stomach with Spontaneous Regression in a Short Period, Report of a Case

要旨　患者は66歳，女性．自己健診目的で当院を受診．胃内視鏡検査では，幽門前庭部小彎後壁に3個のびらんを伴う横に長い，なだらかな立ち上がりの隆起性病変を認めた．内視鏡生検で大型異型リンパ球のびまん性増生がみられ，免疫染色の結果と合わせ胃原発diffuse large B-cell lymphomaと診断した．無治療で，初回内視鏡検査から約3週間後の術前内視鏡検査，X線検査では隆起性病変は，内部に小さな潰瘍と結節を伴う陥凹病変に形態変化を来した．初回内視鏡検査より約4週間後の幽門側胃切除標本では，大型異型リンパ球の浸潤は全くなく，Ul-IIの潰瘍とその周囲の瘢痕組織のみであった．Helicobacter pyloriは陽性であった．胃悪性リンパ腫が約1か月の間に病巣内の潰瘍化により自然脱落，消失したものと考えられた．

　A case of diffuse large B-cell lymphoma (DLBL) of the stomach with spontaneous regression in a month is reported. A 66-year-old female patient visited to the Fukui Prefectural Hospital after a self-medical check. Endoscopic examination revealed a protruded lesion like a submucosal tumor with 3 erosions in the antrum of the stomach. Histopathologic and immunohistochemical examinations of the biopsy specimen showed diffuse proliferation of large-sized atypical lymphocytes, which led to a diagnosis of primary DLBL of the stomach. Three weeks later, preoperative endoscopic and X-ray examination revealed the protruded lesion to be disappearing in spite of not receiving treatment. Distal gastrectomy was performed 26 days after the first examination and histological examination of the resected specimen showed an ulcer (Ul-II) but no lymphoma cells in the lesion. Helicobacter pylori was positive in the gastric mucosa. It was suggested that the lymphoma tissue was lost spontaneously during the month due to exulceration of the lesion.

　1) Department of Pathology, Fukui Prefectural Hospital, Fukui, Japan

　2) Department of Surgery, Fukui Prefectural Hospital, Fukui, Japan