進行胃癌と鑑別困難であった胃原発性悪性リンパ腫の1例

Malignant Lymphoma of the Stomach Difficult to Differentiate from Advanced Gastric Carcinoma

　胃原発性悪性リンパ腫のうち表層型として分類される型は，早期胃癌，多発性胃潰瘍，潰瘍瘢痕，いわゆるreactive lymphoreticular hyperplasiaなどとの鑑別診断が困難である．

　今回，われわれは術前確定診断がつかず，切除標本の病理組織学的検索の結果，“早期”の表層型胃原発性悪性リンパ腫であった症例を提示する．

　症　例

　患　者：森○徳○郎，63歳，男．

　主　訴：心窩部膨満感．

　既往歴：約10年前より高血圧症にて治療中．3年前変形性脊椎症および内痔核．

　家族歴：父は50歳で胃潰瘍にて死亡．母は30歳で胸部疾患で死亡．姉に胃潰瘍の既往あり．

　現病歴：1971年12月に心窩部膨満感が出現したため胃透視を受け，精査目的で当院内科受診．胃X線検査，胃内視鏡検査の結果入院をすすめられた．

　A 63 year-old man consulted a neighborhood physician for abdominal distension and was sent to our hospital for detailed examination. By x-ray examination of the stomach, some irregular niches in the anterior wall of the gastric angle and dam-shaped rises of the surrounding tissues were found. The extension of the gastric antrum was good. By gastric endoscopy, ulcers of irregular shapes were found in the anterior wall of the gastric angle and of the antrum near the greater curvature. By x-ray and endoscopy, the diagnosis was gastric cancer, but by biopsy, no tumor cells were found. However, with a positive suspicion of malignancy, an operation was carried out two months atrer the endoscopy.

　The results of the patho-histological examination were an ulcer scar on the anterior wall of the gastric angle and malignant lymphoma around the ulcer scar. Depth of invasion was limited to the submucosa. The histological view of the tumor cells was histiocytic lymphoma (by Rappaport). No lymph node metastasis was recognized.

　This macroscopic type belongs to the “superficial type” of its classification by Sano.