Ⅱc＋Ⅲ型早期胃癌が疑われたreactive lymphoreticular hyperplasiaの1例

Reactive Lymphoreticular Hyperplasia Suspected of Early Gastric Cancer, Type Ⅱc+Ⅲ, Report of a Case

　胃のreactive lymphoreticular hyperplasia（以下，RLH）は，X線・内視鏡的に，Ⅰ型以外の早期胃癌，悪性リンパ腫，粘膜下腫瘍，良性胃潰瘍と鑑別がなお困難な疾患である．以下，胃潰瘍として経過を追っているうちに早期胃癌が疑われたRLHの症例を呈示する．

　症　例

　患　者：31歳，男，会社員．

　主　訴：空腹時の心窩部痛．

　既往歴：10年前に虫垂切除．

　家族歴：特記することはない．

　現病歴：当科来院6カ月前ごろより空腹時に心窩部痛があり，A医を受診し胃潰瘍と診断された．入院加療を受け，約3週間で症状が軽快したため希望退院した．しかし，1カ月前から再び前回と同様な症状が起こり，B医を受診し，胃X線検査により，胃癌を疑われたため当科を紹介された．

　A case of RLH of 31 year-old man was presented. Initially, this case was diagnosed as gastric ulcer radiologically and endoscopically. During followingup, changes of converging mucosal folds, such as interruption, swelling, sharpness, fusion and wormeaten appearance, appeared around this ulcer.

　These changes strongly suggested a Ⅱc+Ⅲ type of early gastric cancer. Biopsy revealed no malignancy, but marked infiltration of lymphocyte, which was thought to be RLH.

　Partial gastrectomy was performed because of recurrent ulcer and persisting epigastralgia, and further histological examination never showed a complication of cancer cells.

　Therefore, this case was finally diagnosed as RLH.

　Retrospectively,RLH in this case could be positively diagnosed because of partial lack of lesion with Ⅱc and stiffness around entire margin of the ulcer.