4年2ヵ月の経過を観察した胃細網肉腫の1例

Gastric Reticulum Cell Sarcoma Followed Up for Four Years and Two Months

　いわゆるlymphoid hyperplasia（LH）を疑い，約4年2カ月間経過観察を行った胃悪性リンパ腫の1例を経験したので報告する．

症　例

　患　者：38歳，男．

　主　訴：心窩部痛．

　既往歴，家族歴：特記すべきものなし．

　現病歴ならびに経過：1974年7月初旬より心窩部痛が出現し，当科を受診．胃X線検査，内視鏡検査よりLHを疑ったが，確定診断のつかないまま経過観察がなされた．症状は軽快していたが，1975年8月，症状の増悪とともに，検査所見にも異常所見が増大し，胃悪性リンパ腫を強く疑い，手術の目的で入院した．しかし，2カ月後の検査所見で著しい改善を示し，生検にても陰性であったため，更に経過観察をすることになり，その後，来院がとだえがちで放置されていた．1978年7月より再び心窩部痛が激しくなり，同年8月14日入院した．

　A 39-year-old man visited our hospital on July 14, 1974, with a chief complaint of epigastralgia. The initial x-ray and endoscopic examination showed multiple shallow irregular-shaped depressions surrounded by various rounded granular elevations on the posterior wall from the antrum to the lower body of the stomach. As biopsy revealed no abnormality, suspicious diagnosis of so-called lymphoid hyperplasia (LH) of the stomach was made. The patient was placed under observation. Fifteen months later, the lesions became worse and more extensive compared with the findings at the initial examination. Although malignant lymphoma was highly suspected, as erosions and ulcers almost disappeared after two months and repeated biopsy was negative for malignancy, he was again placed under observation. Two years and eight months later, x-ray and endoscopic examination showed large irregular-shaped depression surrounded by low elevation and with smooth surface on the posterior wall from the antrum to the mid-body. These findings, were characteristic of malignant lymphoma. Total gastrectomy was performed on September 12,1978. On the resected specimen, a depressed lesion measuring 13×10 cm with marginal elevation was seen. Histologically, reticulum cell sarcoma invaded the upper part of the proper muscle layer, partially to the serosa.

　Follow up study of this case, for four years and two months, has given many instructive problems about its early diagnosis and possibility of the change from LH to malignant lymphoma.