良悪性の診断が困難であった胃悪性リンパ腫の1例

Malignant Lymphoma Difficult to Differentiate from Lymphoid Hyperplasia

　胃体下部大彎を中心に多発のびらんと潰瘍を認め，胃X線，内視鏡にて良悪性の鑑別が困難であり，組織学的にも境界領域病変としての性格を有したリンパ腫を経験したので報告する．

　症　例

　患　者：S. N.，53歳，女．

　主　訴：空腹時心窩部痛．

　既往歴：27歳虫垂切除術．50歳子宮筋腫にて子宮全摘術．6年前より高血圧症にて加療中．

　家族歴：母親が胃癌で死亡．

　現病歴：1977年初めごろより空腹時心窩部痛あり，胃X線，内視鏡検査を受け，胃体部の潰瘍性病変を指摘されlymphoid hyperplasia（LH）あるいは悪性リンパ腫も考えられたが，生検にて特記すべき所見なく，内科的治療を行った．その後，経過中に行ったX線，内視鏡所見から悪性リンパ腫が疑われ，1978年10月手術のため入院した．

　A 53 year-old woman visited our hospital with a complaint of hunger pain. Several erosions and ulcers in the body of stomach were found at x-ray and endoscopy examination and lymphoid hyperplasia (LH) was suspected from these findings. Biopsy from these lesions showed no value for correct diagnosis.

　After one year of follow-up, the x-ray examinations showed several small irregular barium flecks and various size of granulations on the lesser curvature of the upper part of the body. Similar lesions were also seen on the mid-body up to the lower part of body. Endoscopic examination showed several erosions with white coat, granulations and redness on the greater curvature of the lower part of the body. Shallow irregular depressions were newly checked on the lesser curvature of the upper part of the body in this examination.

　Pre-operative diagnosis was difficult. The characteristics of malignant lymphoma were not recognized, but biopsy examination revealed findings suggestive of malignant lymphoma.

　Subtotal gastrectomy was performed. Even in macroscopic examination, it was very difficult to differentiate malignant lymphoma from multiple ulceroerosive type of LH. With histological study, these lesions were limited to mucosal and submucosal layer in most part, but reached the muscular layer in part. The histological characteristics of LH were revealed, but in one part, those of malignant lymphoma were also seen because of atypia in the level of tumor cell and lymph follicles.

　On the whole, it might be more typical to diagnose such lesions as malignant lymphoma, but this case was an interesting one, when taking the histogenesis and the borderline lesions between LH and malignant lymphoma into consideration.