びまん型のreactive lymphoreticular hyperplasiaの1例

Diffuse Flat Type Reactive Lymphoreticular Hyperplasia, Report of a Case

　症　例

患　者：55歳，男．

主　訴：心窩部鈍痛．

家族歴，既往歴：特記することなし．

現病歴：5年前より，ときどき心窩部鈍痛．1978年4月，健康診断のX線検査で異常ありと言われたが放置（LPCクリニックの写真，Fig. 1と2）．1年後に空腹時の鈍痛が起こり近医を受診．異常を指摘され，当院に紹介された．

　A 55 year-old man came to our hospital with a five-year history of epigastric discomfort. At a barium meal study, irregularity and stiffness of the lesser curvature were seen on the erect barium-filled view and the supine double contrast views showed a poorly defined area of mucosal granularity with multiple erosions. He had a barium meal study done 15 months ago in an other clinic, and similar x-ray findings were retrospectively seen.

　At gastroscopy, the mucosa of the antrum and angular region looked fragile with multiple erosions or petechiae. Biopsy specimens taken from the fragile mucosa were reported as showing rather dense infiltration of inflammatory cells, particularly of lymphocytes. There was no histological evidence of epithelial neoplasm. Gastroscopy with biopsy was repeated to exclude malignant lymphoma but gastroscopic findings remained the same for nearly two months. Histological findings of biopsy specimens taken at repeated gastroscopy were highly suggestive of reactive lymphoreticular hyperplasia, and therefore, subtotal gastrectomy was done.

　In the resected specimen, a poorly defined area of superficial mucosal depression with multiple erosions and converging folds was noted. Histological examination of the resected specimens showed 5×8.5 cm sized ulceration (Ul-Ⅱ) with diffuse infiltration of lymphocytes, and the histological diagnosis was reactive lymphoreticular hyperplasia.