慢性骨髄単球性白血病における白血病細胞の大腸浸潤

Lukemia Cells of Chronic Myelomonocytic Leukemia（CMMoL）Infiltration to the Colon

要旨　CMMoLのAML（M4）への急性白血病化と時を同じくして下痢および血便を来し，直腸から盲腸まで連続性に多発する頂部にびらん，もしくは白苔を伴うリンパ濾胞様の小隆起性病変を呈した白血病細胞の大腸浸潤の1例を経験した．CMMoLの大腸granulocytic sarcomaは極めてまれであり，これまでの報告はわずか2例であるが，本症例の病変の肉眼形態はそのいずれとも異なっていた．診断確定時には患者の全身状態が悪く原疾患への治療を行うことができなかった．疾患頻度の低さから現時点での確立された治療法はなく，今後の課題と考えられた．

　A woman in her sixties with a 5 month history of CMMoL was admitted to Fujita Health University Hospital because of left flank pain in March, 2008. After admission, abdominal pain reduced but diarrhea and melena appeared, so colonoendoscopy was indicated. Numerous small round elevated lesions like multiple lymphomatous polyposis with erosion or fibrin plaque on their tops were found from the recum to the cecum. Leukemia cell infiltration to the mucosa was revealed histopathologicaly in all biopsy specimens. But when we made this diagnosis, the patient's condition was very severe, so she could not be receive curative therapy. Granulocytic sarcoma of the colon associated CMMoL is very rare and only 2 cases have been reported before. Including our case, macroscopic findings differed.