悪性リンパ腫を疑い除菌療法にて著明な改善を認めた胃潰瘍性病変の1例

Gastric Ulcer-like Lesions in which Malignant Lymphoma was Suspected and which Showed Marked Improvement as a Result of H. pylori Eradication Therapy, Report of a Case

要旨　症例は32歳，男性．心窩部痛を主訴に近医を受診．上部消化管内視鏡検査にて多発性胃潰瘍と診断され，H₂RAやPPIの投与を受ける．しかし，潰瘍の治癒傾向が全く認められず，悪性リンパ腫なども否定できず精査目的に当科受診となる．当院で行った胃内視鏡検査でも多発性不整形潰瘍を認め，悪性リンパ腫を強く疑った．胃生検組織所見や全身検索の結果，悪性リンパ腫の確証は得られなかった．そこで，Helicobacter pylori陽性のPPI抵抗性難治性潰瘍として除菌療法を行ったところ，潰瘍の著明な改善を認めた．以後の経過観察中に脾臓に腫瘤性病変が発生した．脾摘を行い病理組織学的にPTCL（peripheral T-cell lymphoma，unspecified）と診断された．胃病変は全経過を通じて再発を認めなかった．胃病変と脾腫瘍は現時点では別病変と考えている．

　The case was that of a 32-year-old man. At first, he visited a neighborhood doctor complaining of epigastric pain. The diagnosis of multiple gastric ulcers was made as a result of upper gastrointestinal endoscopy, and he received treatment with an H₂RA and PPI. However, the ulcers showed no sign of improvement. Because the possibility of other diseases such as malignant lymphoma could not be ruled out, he was referred to this hospital for detailed examinations. Gastric endoscopy conducted at this hospital also showed multiple, irregular ulcers, and malignant lymphoma was strongly suspected. However, based on gastric biopsy or general examinations, the diagnosis of malignant lymphoma could not be confirmed. H. pylori eradication therapy was undertaken under the diagnosis of H. pylori-positive, PPI-resistant refractory ulcers. The ulcers improved markedly. Tumorous lesions occurred in the spleen during the post-treatment follow-up. Splenectomy was then conducted, and a histopathological diagnosis of unspecified PTCL (peripheral T-cell lymphoma) was made. Gastric lesions showed no sign of recurrence throughout the observation period. At this stage, the gastric lesions are not thought to have been related to the splenic tumor.