2) 悪性リンパ腫

Primary Small Intestinal Lymphoma: A Review with Special Reference to the Correlation Between its Macroscopic and Histologic Features

要旨　小腸原発悪性リンパ腫の臨床病理学的特徴と画像所見について，自験例を中心に概説した．組織型では，びまん性大細胞型B細胞性リンパ腫が最も多く，胃原発例と比べ，MALTリンパ腫は少なく，T細胞性リンパ腫や濾胞性リンパ腫の頻度が高い．X線・肉眼分類では隆起型，潰瘍型（狭窄・非狭窄・動脈瘤），MLP型，びまん型，その他に分類され，組織型と相関がみられる．治療は，病変の範囲，組織型および病期に応じて，手術，化学療法，抗菌剤治療，watch and waitなどが選択され，限局例では外科的切除＋術後化学療法が一般的である．予後は胃原発例より不良である．各組織型に特徴的な画像所見を理解して，適切な画像診断を行うことが重要である．

　The clinicopathological features of patients with primary small intestinal lymphoma were reviewed. Histologically, diffuse large B-cell lymphoma (DLBCL) is most frequently observed. Compared to primary gastric cases, MALT lymphoma is less frequent, while T-cell lymphoma and follicular lymphoma are more frequent in primary small intestinal cases. Macroscopically, small intestinal lymphomas are classified as either polypoid, ulcerative (including stricturing, non-stricturing and aneurysmal forms on radiography), multiple lymphomatous polyposis, diffuse, or other types. A significant correlation is observed between these macroscopic/radiographic and histologic types. The therapeutic strategy, such as surgery, chemotherapy, antibiotics or watch-and-wait, should be determined based on the disease extent, histologic type, and clinical stage.