胃の非上皮性腫瘍の細胞診

Cytology of Nonepithelial Tumors of the Stomach

はじめに

　筆者らの教室における胃の非上皮性腫瘍は25例で，そのうち3例の胃壁内迷入膵および3例の炎症性肉芽腫を含んでいる．これは教室の切除胃2,400例に対して，約1％の頻度にあたる．明らかな良性腫瘍例は11例で，8例は胃原発性悪性リンパ腫である．これらの非上皮性腫瘍は術前の胃X線検査，内視鏡によっても，胃癌との鑑別の困難な症例が多く，これらの症例の19例に細胞診を施行した．その経験例をもとに胃癌と鑑別すべき細胞について，悪性リンパ腫例を中心に述べてみたい．

　A total of 25 cases of nonepithelial gastric tumors, including three each of eosinophlic granuloma and the aberrant pancreas, have been surgically treated by us. This number corresponds to about 1 per cent of all the gastric resections (2,400 cases) performed by us so far. Nineteen cases were examined by the combined use of x-ray, endoscopy and exfoliative cytology. The last procedure failed to demonstrate all of 13 cases of benign tumors, but it confirmed all but one of six cases of malignant lymphoma. X-ray and endoscopy, though successful in visualizing malignancies, were such that all cases of malignant lymphoma were regrettably mistaken either for cancer or ulcer. It is especially noteworthy that the most recent three cases of malignant lymphoma have all been correctly diagnosed as such by cytology. Since at present exact differentiation between gastric cancer and sarcoma is difficult by x-ray and endoscopy alone, exfoliative cytology and biopsy must be coemployed in the diagnosis of gastric sarcoma. Only then would it be more accurate.

　Characteristic patterns of cells of malignant lymphoma are further discussed together with cytological differentiation between it and carcinoma, with special emphasis on the usefulness of exfoliative cytology in the diagnosis of gastric malignancy.