小腸悪性リンパ腫の診断―臨床像と形態学的所見の特徴

Diagnosis of Malignant Lymphoma of the Small Intestine―Clinical Feature and Morphological Findings

要旨　小腸悪性リンパ腫（ML）の腸管病変や病理組織学的所見の特徴を中心に検討した．対象は小腸原発ML23例である．病変部位は空・回腸18例，十二指腸5例で，病変数は単発16例，多発7例であった．X線造影を中心に評価した肉眼型は，空・回腸MLは潰瘍型が9例で最も多く，以下隆起型5例，動脈瘤型3例などであった．十二指腸MLは，隆起型が3例を占め多かった．組織型はB細胞由来が21例を占め，内訳はdiffuse large B-cell lymphomaが17例，follicular lymphomaが4例であった．前者は潰瘍型から隆起型まで種々の肉眼形態を呈したが，後者は多発する白色顆粒状隆起が特徴的所見であった．小腸MLの肉眼形態は病理組織学的所見を反映するものと考える．

　We mainly examined the morphologic and pathohistologic findings of primary small intestinal malignant lymphomas (ML). The subjects were 23 cases of small intestinal ML. Eighteen cases were located in the jejunum or ileum, and the other 5 cases in the duodenum. The lesions were solitary in 16 cases and multiple in 7 cases. Macroscopic form of the small intestinal ML, mainly evaluated by radiographic findings, were classified as ulcerative in 10, protruded in 8, aneurysmal in 3 and mixed in 1 case. Histologically, 17 cases were diffuse large B-cell lymphomas, 4 cases were follicular lymphomas and 2 cases were peripheral T-cell lymphomas. The lesions with diffuse large B-cell lymphomas showed several macroscopic forms, such as ulcerative, protruded and aneurismal forms. Most of the cases with follicular lymphomas showed multiple small sized granular lesions with white surface. One case, with peripheral T-cell lymphoma in the jejunum and ileum, showed multiple ulcers with diffuse thickness of the folds.

　It was concluded that some correlations between macroscopic forms and pathohistologic findings were able to be recognized in malignant lymphoma of the small intestine.