ダブルバルーン内視鏡が診断に有用であった空腸原発T細胞性リンパ腫の1例

Primary T-Cell Lymphoma of the Jejunum Diagnosed by Double-Balloon Endoscopy, Report of a Case

要旨　症例は57歳，男性．下血を主訴に当院を受診した．上下部消化管内視鏡にて出血源を同定できなかったために，ダブルバルーン内視鏡を施行した．経口的挿入にて空腸下部に3/4周性の周堤を有する潰瘍性病変を認めた．観察可能な範囲では空腸に限局する病変であった．生検にてT細胞性リンパ腫と確定診断した．CT，ガリウムシンチグラフィー等にて他臓器病変を認めず，限局性の病変であることから腹腔鏡補助下空腸部分切除術を施行した．切除検体の病型は細胞傷害性T細胞性リンパ腫の範疇に帰属する悪性リンパ腫であり，深達度はse，腸間膜リンパ節にはリンパ腫細胞の浸潤巣は認めなかった．術後，CHOP療法を7コース施行し，無再発生存中である．

　A 57-year-old male patient complaining of recurrent hematochezia was referred to our hospital. Upper and Lower GI endoscopy did not reveal the origin of the bleeding, so we performed double-balloon endoscopy. In the trans-oral approach, an ulcerative lesion with marginal elevation was detected in the lower part of the jejunum. As far as we could observe, the lesion was localized in the jejunum. By biopsy specimens, we were able to diagnose with certainty a T-cell lymphoma. No other lesions were able to be detected by CT and Garium scintigraphy. The patient underwent laparoscopic assisted partial resection of the jejunum. Histology of the resected specimen defined it as a category of cytotoxic T-cell lymphoma. The depth of the lesion was subserosa and there was no lymph-node involvement. The patient received 7 courses of chemotherapy (R-CHOP) after surgery and then recovered his well-being without recurrence of the disease.