びまん性の小腸病変を有したenteropathy-type T-cell lymphomaの1例

Enteropathy-type T-cell Lymphoma with Diffuse Infiltration Findings of the Small Bowel, Report of a Case

要旨　患者は68歳，男性．腸炎症状で発症し蛋白漏出症候群および吸収不良症候群を伴った．画像所見では十二指腸より上部小腸を中心に，ほぼ全小腸にびまん性のKerckring皺襞の著明な肥厚と粘膜の微細顆粒状の変化を呈した．内視鏡下生検病理組織で粘膜固有層に著明な異型リンパ球の浸潤がみられ，免疫組織化学法の結果と合わせ細胞障害性T細胞性悪性リンパ腫と診断した．本症例は化学療法の効果が期待できないと判断し，中心静脈栄養などの対症療法のみ行い，診断約10か月後に絞厄性と思われる腸閉塞を来し急死した．

　A sixty-eight-year-old male patient complaining of abdominal pain and diarrhea which mimicked enteritis-like symptoms was referred to our hospital. Laboratory test and absorption test revealed that he was suffering from protein-losing　enteropathy and malabsorption syndrome. Radiographic and endoscopic study showed diffuse thickening and coarse granular mucosa in the whole duodenum and the whole small intestine. Endoscopic biopsy revealed thick mucosal infiltration of lymphoma cells which, by immuno-histochemical staining, were diagnosed as of T-cell origin (enteropathy-type T-cell lymphoma). Because it is known that this type of lymphoma has very poor prognosis even after strong chemotherapy, this patient received conservative nutritional therapy but did not receive any chemotherapy. Ten months later he died suddenly because of a necrotizing ileus.