胃と腸49巻5号

2014年05月発行

増刊号 消化管悪性リンパ腫2014

主題 消化管原発low-grade lymphoma―MALTリンパ腫

胃MALTリンパ腫の診断と治療―診断

著者： 田近正洋¹ 中村常哉² 田中努¹ 石原誠¹ 谷田部恭³ 山雄健次⁴ 丹羽康正¹

所属機関： ¹愛知県がんセンター中央病院内視鏡部 ²中村内科クリニック ³愛知県がんセンター中央病院遺伝子病理診断部 ⁴愛知県がんセンター中央病院消化器内科部

ページ範囲：P.603 - P.615

文献概要

胃MALTリンパ腫の病態は，H. pylori除菌療法の反応性とAPI2-MALT1融合遺伝子の有無から，responderでAPI2-MALT1陰性のA群，non-responderでAPI2-MALT1陰性のB群，non-responderでAPI2-MALT1陽性のC群の3群に分類される．内視鏡所見は多彩であるが，各群の特徴は，A群：びらん，早期胃癌類似など表層性変化，B群：粘膜下腫瘤様隆起，C群：cobble stone粘膜である．NBI併用拡大内視鏡検査の特徴的な所見は，腺管構造が消失，破壊された領域に異常血管を認めることである．胃癌との鑑別では，明瞭なdemarcation lineを有さないこと，個々の血管の大小不同や口径不同を有さないことが重要である．微細構造や微細血管の変化に着目し，狙撃生検を行うことが正確な診断を行ううえで重要である．

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