消化管follicular lymphomaの特徴：臨床的立場から―内視鏡を中心に

Clinical and Endoscopic Features of Primary Follicular Lymphoma of the Gastrointestinal Tract

要旨　消化管原発follicular lymphoma（以下FL）10例について内視鏡所見の特徴を中心に検討した．病変部位は10例全例で十二指腸に病変を認め，バルーン小腸内視鏡を施行した9例中8例（88.9％）に空腸，4例（44.4％）に回腸に同時に病変を認めた．内視鏡所見は十二指腸および空腸病変は白色顆粒状隆起が集簇あるいは融合していた．一方，回腸病変は周囲健常粘膜と同じ色調の多発性隆起性病変と認識されることが多く，リンパ濾胞の過形成と鑑別が困難であった．治療は全例でrituximabを含むR-CHOP療法を行って完全寛解した．消化管原発FLは十二指腸だけでなく，空腸や回腸にも病変が浸潤していることが多く，病期診断の際には通常の画像診断に加え，バルーン小腸内視鏡による全小腸の検索が必要と考えられた．

　To elucidate distinctive features of primary follicular lymphoma (FL) of the gastrointestinal (GI) tract, we studied 10 patients with primary FL of the GI tract. All patients except one underwent endoscopy of the entire GI tract using balloon enteroscopy (BE) added to conventional esophagogastroduodenoscopy and colonoscopy. Characteristic endoscopic findings of primary FL of the GI tract were clusters of multiple whitish granular lesions. These findings were recognized in the duodenum in all 10 patients, and in the jejunum in 8 of 9 patients (88.9％). On the other hand, endoscopic findings of FL in the ileum were different from those of the duodenum and the jejunum, and it was difficult to distinguish FL from lymphoid hyperplasia in the terminal ileum. Multifocal lesions were observed in the ileum in 4 (44.4％). We performed 5 or 6 courses of chemotherapy including the administration of rituximab in all patients, and complete regression was achieved in all patients.

　When we consider the selection of a therapeutic plan for primary FL of the GI tract, total enteroscopy using BE should be added to the conventional examination before treatment.