代表的な免疫異常状態における消化管病変の特徴―ATL/L

Characteristics of Gastrointestinal Tract Lesions in a Representative Immunodeficiency State: ATL/L

要旨　ATL/L（adult T-cell leukemia/lymphoma）において，免疫不全状態を背景として消化管に発生する病変を，自験例191例を対象として検討した．ATL細胞浸潤による消化管病変の肉眼形態は，臓器により異なり，胃では混在型が，小腸では多発隆起型が多い傾向がみられた．ATL/L以外の消化管の悪性リンパ腫との比較では，多発性，びまん性の傾向がみられた．消化管の日和見感染は，4.2％に認められ，化学療法による骨髄抑制に伴う免疫不全または，ATL/Lそのものの病勢の進行による免疫不全が背景と考えられた．また，ATL/Lでは，HTLV-1感染により，キャリアーの時期から免疫能の軽度の低下があるとされており，これを背景とした糞線虫症の合併や，他臓器癌の合併についても言及した．

　I reviewed 191 cases of ATL/L (adult T-cell leukemia/lymphoma) for gastrointestinal lesions which develop on the basis of immunodeficiency. The macroscopic features of gastrointestinal lesions developed by ATL-cell infiltration were different among organs affected. Mixed type was most frequently seen in the stomach and multiple elevated lesions were most frequently observed in the small intestine. There was a higher tendency in ATL/L cases towards the formation of diffuse or multiple lesions than in non-ATL/L cases of malignant lymphoma of the gastrointestinal tract.

　Opportunistic infection of the digestive organs was seen in 4.2 ％ of the cases. Immunodeficiency caused by myelosuppression by chemotherapies or by progression of ATL/L itself was thought to be the background of opportunistic infection. It is known that a mild immunodeficiency state exists from an early stage or carrier state of HTLV-1 infection. Strongyloides infection related to this mild immunodeficiency state and the complication of cancer of other organs were also referred to.