診断に難渋した狭窄を呈する小腸follicular lymphomaの1例

Primary Follicular Lymphoma of the Jejunum with Stricture, Reports of a Case

要旨　患者は60歳，男性．タール便と貧血のため近医より当科を紹介され受診となった．ダブルバルーン小腸内視鏡にて空腸に全周性の潰瘍を伴う狭窄性病変が指摘された．生検を行ったが悪性所見はなく確定診断は得られなかった．1年後の内視鏡再検査時の生検にてFL（follicular lymphoma）と診断した．CTでは大動脈周囲と腸間膜のリンパ節の腫大を認め，Lugano国際分類Stage II₂期であったため，治療は化学療法を選択した．リツキシマブを併用したCHOP療法を7クール行い完全寛解し，3年経過しているが再燃は認めていない．FLでは，白色顆粒状病変として発見されることが多く，発症時から狭窄病変として示される症例はまれである．

　A 60-year-old male was admitted to our hospital complaining of tarry stool. A jejunal stenosis with a circumferential ulcer was pointed out by double-balloon endoscopy（DBE）, but definitive diagnosis was not obtained. Follow-up DBE with biopsy performed one year later resulted in a diagnosis of follicular lymphoma. The patient underwent chemotherapy with a regimen of cyclophosphamide, doxorubicin, vincristine, and predonisolone combined with rituximab（R-CHOP）. Complete regression of the tumor was achieved, and recurrence of follicular lymphoma is not recognized 3years after the chemotherapy. Thanks to the advance of DBE, we can make both histological diagnosis of malignant lymphoma in the small intestine and clinical staging without resorting to surgery. Our case indicates that this type of follicular lymphoma can occur in this location and present with the features of a stenotic lesion.