多彩な胃病変を伴ったlymphomatoid granulomatosis（LYG）の1例

Lymphomatoid Granulomatosis with Gastric Involvement, Report of a Case

要旨　極めてまれな合併症である胃病変を伴ったLYGの1例を報告すると共に，本症の臨床像，組織像，治療およびリンパ腫との関係などにつき略述した．患者は60歳，男性．食欲不振，体重減少を主訴として来院，諸検査の結果，肺，胃，腎，皮膚，末梢神経に病変を認め，生検所見よりLiebowらの記載したLYGに合致する疾患と診断した．本症例は経過中に3度胃病変の出現を認めた．つまり，第1回入院時には非連続性に潰瘍，腫瘤，および肥厚した粘膜ひだが混在しており，また第2回入院時には単発性の大きな腫瘤を，更に第3回入院時には非連続性の多発性隆起性病変と非常に多彩な変化を呈した．LYGの薬物療法はいまだ確立されていないが，前2回の病変に対しPDNとCPAの併用療法は有効であった．LYGの胃X線および胃内視鏡所見に関する報告は外国文献をみてもなく，この報告が最初のものである．

　Lymphomatoid granulomatosis (LYG) is a rare disease in Japan. It may predominantly involve the lung, the skin, the central and peripheral nervous system, the kidneys and other organs in various degrees. GI tract involvement, especially gastric lesions, however, is quite rare. We report here a case of LYG with gastric involvement which has been followed radiographically and endoscopically for two years and nine months.

　The patient, a 60-year-old man was admitted to our hospital complaining of weight loss in June 1981. Examinations showed multiple coin lesions in both sides of the lung, multiple interrupted gastric lesions, peripheral polyneuropathy, skin lesions, and a tumor in the left kidney. The diagnosis of LYG was made from the biopsy specimens from the lung, stomach and skin.

　With regard to the gastric involvement of LYG, only two cases of an operated ulcerative lesion have been reported to date. Our case, however, showed multiple, interrupted and diversified lesions which had an mixed ulcerative, polypoid and infiltrative appearance, and this resembled that of malignant lymphoma.

　The patient showed marked improvement for sometime on PDN and CPA therapy, but relapsed with gastric elevated lesion in May 1983. In March 1984, there were multiple coin lesions in the lung and multiple elevated lesions in the stomach. At present he is being kept under careful observation with PDN and CPA therapy.