⑤多発微小胃悪性リンパ腫の1例

Multiple Ⅱc-simulating Malignant Lymphomas Limited to the Mucosal Membrane

患　者：69歳，女．

主　訴：無症状．

現病歴：1978年9月下旬，老人検診で胃X線検査を受け，幽門部の変形を指摘された．同年9月29日近医で精密検査を受け，幽門前庭部大彎の悪性病変を疑われ，同年10月9日癌研内科を受診した．

　A 69 year-old female patient visited the dep. of internal medicine on October 9, 1978 in order to have the detailed examination of the stomach. On May 20, 1978 she was examined with mass survey of the stomach by x-ray, which revealed deformity of the antrum. The x-ray examination done on September 29, 1978 by the neighboring doctor suspected of malignancy of the gastric antrum.

　The x-ray examination after admission (October 9, 1978) to the dep. of internal medicine, Cancer Institute Hospital (Figs. 1, 2 and 3) revealed highly suspicious findings of malignacy in the anterior wall and the greater curvature of the antrum. The endoscopic findings were also suggestive of malignancy, but repeated biopsy (3 times) was negative for malignancy. Operation was performed on December 22, 1978 under the strong suspicion of malignancy in spite of the negative biopsy. At operation no mass was palpable in the stomach. There was no metastasis in the lymph nodes, liver and peritoneium (N₀, H₀, P₀, S₀). Radical operation (R1) could be done.

　The resected stomach revealed a linear ulcer with the converging folds at the greater curvature of the antrum and two small mucosal elevations with central depression at the anterior wall of the antrum (Fig. 8).

　Histological examination revealed that two mucosal elevations were malignant lymphoma (diffuse, poorly differentiated, lymphocytic) which were limited only to the mucosal membrane. Another minute lesion of malignant lymphoma (c) was discovered incidentally near the lesion b.