胃reactive lymphoreticular hyperplasiaにて胃切除後7年半再発をみない1例

Reactive Lymphoreticular Hyperplasia of the Stomach Followed Up for Seven and a Half Years after Operation without Recurrence

　胃X線検査，内視鏡検査にて多発潰瘍を有する胃reactive lymphorcticular hyperplasia（以下，胃RLH）と診断し，胃切除後7年半再発をみない1例について報告し，鑑別診断を中心に考察を加える．

　症　例

　患　者：鳥○志○○，45歳，女．

　主　訴：空腹時の腹部膨満感．

　既往歴：33歳，第2児分娩後より無月経．

　家族歴：悪性腫瘍なし．

　約2ヵ月間続く食事摂取にて改善する腹部膨満感にて，1972年11月，藤田胃腸科病院に入院となる．腹痛なく，食欲良，便通異常なく，体重45kg増減なし，であった．現症は特記すべきことはなかった．

　A 45 year-old female was admitted to the hospital because of abdominal fullness. Although the symptom subsided, x-ray and endoscopy revealed various changes for three months until the operation. On admission there appeared to be small ulcers and irregular nodularity from the lower body to the antrum. A month later the ulcers became smaller but nodularity and multicentral converging folds became more remarkable. A direct-vision gastric biopsy revealed gastritis with ulcerated lesion.

　Reactive lymphoreticular hyperplasia of the stomach was mostly suspected and so partial gastrectomy was performed.

　The operated material showed irregularly shaped excavation from the lower body to the antrum with abruption of folds of oral edge. Histologic examination disclosed that reactive lymphoreticular hyperplasia accounted for the macroscopic findings. Lymphoreticular cells with germinal centers were seen in the lamina propria mucosa and submucosa in the intermediate zone of the fundic and pyloric mucosa. Multiple erosions and ulcers of Ul‐Ⅱ with scanty regenerative cells were also seen in the lesion. On the other hand fundic and pyloric glands were markedly atrophic.

　Postoperative progress was satisfactory and upper G-Ⅰ series revealed no recurrence after seven and a half years.