内視鏡所見の得られたenteropathy-typeT細胞性リンパ腫の1例

Enteropathy-type T-cell Lymphoma in which Double-balloon Enteroscopy was Performed, Report of a Case

要旨　症例は60歳代前半の男性．約1年前より水様下痢が出現していたが，2か月前より腹部膨満感，食思不振，嘔吐が出現するようになったため当院に入院した．ダブルバルーン小腸内視鏡で全小腸を観察したところ，広範な浮腫状変化と散在する大小のびらんを認めた．びらんは回腸に多く，輪状に分布する傾向がみられた．また回腸に全周性潰瘍を伴う高度狭窄を認めた．小腸狭窄に対し小腸部分切除術を施行した．病理組織学的検査では粘膜下層中心にやや小型の異型リンパ球がびまん性に浸潤し，免疫染色にてCD3陽性でありT細胞リンパ腫の所見であった．吸収不良症候群を伴うことより，enteropathy-type T細胞性リンパ腫と診断した．

　A man in his early sixties came to our hospital complaining of chronic diarrhea continuing for one year. Thereafter, bloating, anorexia and vomiting appeared, and he was admitted. Since computed tomographty of the abdomen revealed segmental ileal thickening, enteroscopy using the double-balloon method was attempted. It revealed edematous mucosa and scattered erosions of various size mainly in the ileum. A severe stenosis with circular ulceration was observed in the ileum. Accordingly, partial resection of the stenotic segment was carried out. Histology of the resected specimen showed massive and diffuse infiltration of small atypical lymphocytes mainly in the submucosal layer. Immunohisitologicaly these lymphocytes were positive for CD3. Considering the presence of malabsorption syndrome, the diagnosis of enteropathy-type T-cell lymphoma was made.