Yorita Kenji, Iwasaki Takehiro, Uchita Kunihisa, Kuroda Naoto, Kojima Koji, Iwamura Shinichi, Tsutsumi Yutaka, Ohno Akinobu, Kataoka Hiroaki
Kenji Yorita, Naoto Kuroda, Department of Diagnostic Pathology, Japanese Red Cross Kochi Hospital, Kochi-city, Kochi 780-8562, Japan.
World J Gastrointest Endosc. 2017 Aug 16;9(8):417-424. doi: 10.4253/wjge.v9.i8.417.
Russell body gastritis (RBG) is an unusual type of chronic gastritis characterized by marked infiltration of Mott cells, which are plasma cells filled with spherical eosinophilic bodies referred to as Russell bodies. It was initially thought that () infection was a major cause of RBG and that the infiltrating Mott cells were polyphenotypic; however, a number of cases of RBG without infection or with monoclonal Mott cells have been reported. Thus, diagnostic difficulty exists in distinguishing RBG with monoclonal Mott cells from malignant lymphoma. Here, we report an unusual case of an 86-year-old-Japanese man with -positive RBG. During the examination of melena, endoscopic evaluation confirmed a 13-mm whitish, flat lesion in the gastric antrum. Magnification endoscopy with narrow-band imaging suggested that the lesion was most likely a poorly differentiated adenocarcinoma. Biopsy findings were consistent with chronic gastritis with many Mott cells with intranuclear inclusions referred to as Dutcher bodies. Endoscopic submucosal dissection confirmed the diagnosis of RBG with kappa-restricted monoclonal Mott cells. Malignant lymphoma was unlikely given the paucity of cytological atypia and Ki-67 immunoreactivity of monoclonal Mott cells. This is the first reported case of RBG with endoscopic diagnosis of malignant tumor and the presence of Dutcher bodies.
拉塞尔小体胃炎（RBG）是一种特殊类型的慢性胃炎，其特征是莫特细胞显著浸润，莫特细胞是充满球形嗜酸性小体（称为拉塞尔小体）的浆细胞。最初认为（）感染是RBG的主要原因，且浸润的莫特细胞是多表型的；然而，已有一些无（）感染或有单克隆莫特细胞的RBG病例报道。因此，区分伴有单克隆莫特细胞的RBG与恶性淋巴瘤存在诊断困难。在此，我们报告一例86岁日本男性的罕见RBG阳性病例。在检查黑便期间，内镜评估证实胃窦有一个13毫米的白色扁平病变。窄带成像放大内镜检查提示该病变很可能是低分化腺癌。活检结果与伴有许多有核内包涵体（称为达彻小体）的莫特细胞的慢性胃炎一致。内镜黏膜下剥离术证实诊断为伴有κ链限制单克隆莫特细胞 的RBG。鉴于单克隆莫特细胞的细胞学异型性和Ki-67免疫反应性较少，恶性淋巴瘤的可能性不大。这是首例经内镜诊断为恶性肿瘤且存在达彻小体的RBG病例报告。
