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Stomach and Intestine(Tokyo) Volume 46, Issue 3 （March 2011）

胃と腸 46巻3号（2011年3月発行）

Japanese English

今月の主題免疫不全状態における消化管病変

主題症例

消化管Kaposi肉腫を合併したHIV感染症の2例 Kaposi's Sarcoma of the Gastrointestinal Tract in HIV Infection, Report of Two Cases 小川栄一 ¹ , 村田昌之 ¹ , 池崎裕昭 ¹ , 居原毅 ¹ , 高山耕治 ¹ , 豊田一弘 ¹ , 貝沼茂三郎 ¹ , 澤山泰典 ¹ , 古庄憲浩 ¹ , 江㟢幹宏 ² , 松本主之 ² , 後藤綾子 ³ , 山元英崇 ³ , 林純 ¹ Eiichi Ogawa ¹ , Masayuki Murata ¹ , Hiroaki Ikezaki ¹ , Takeshi Ihara ¹ , Koji Takayama ¹ , Kazuhiro Toyoda ¹ , Mosaburo Kainuma ¹ , Yasunori Sawayama ¹ , Norihiro Furusyo ¹ , Motohiro Esaki ² , Takayuki Matsumoto ² , Ayako Goto ³ , Hidetaka Yamamoto ³ , Jun Hayashi ¹ ¹九州大学病院総合診療科 ²九州大学大学院病態機能内科学 ³九州大学大学院医学研究院形態機能病理学 ¹Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan ²Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan ³Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan キーワード： HIV , highly active antiretroviral therapy , Kaposi肉腫 , human herpesvirus-8 , pegylated liposomal doxorubicin Keyword: HIV , highly active antiretroviral therapy , Kaposi肉腫 , human herpesvirus-8 , pegylated liposomal doxorubicin pp.303-309

発行日 2011年3月25日 Published Date 2011/3/25

DOI https://doi.org/10.11477/mf.1403102158

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要旨　HIV感染者は，日和見腫瘍として悪性腫瘍を発症しやすい．その中でもKaposi肉腫が多く，その病因はhuman herpesvirus-8感染である．〔症例1〕は23歳男性で，十二指腸から上部空腸にKaposi肉腫が認められた．病変は肺にも拡がっており，HAART（highly active antiretroviral therapy）と抗癌剤（pegylated liposomal doxorubicin）を併用したが，肺病変の進行により，入院5か月後に死亡した．〔症例2〕は35歳男性で，食道～上行結腸にかけて広範囲にKaposi肉腫が認められた．HAART単独で改善し，1年後の内視鏡検査で病変は消失した．消化管Kaposi肉腫は赤紫色調の粘膜下腫瘤であり，比較的特徴的な内視鏡像を示す．

　KS（Kaposi's sarcoma）is commonly observed in untreated male homosexual human immunodeficiency virus infected individuals and is associated with advanced immune deficiency. The etiology of KS is thought to be human HHV-8（human herpesvirus-8）, and KS of the gastrointestinal tract is usually asymptomatic.

　〔Case 1〕A 23-year-old male Japanese was diagnosed with AIDS（acquired immunodeficiency syndrome）and KS, which was found on endoscopy not only in the duodenum and upper jejunum, with several ulcerous lesions, but in multiple organs such as the lungs, lymph nodes, and heart. Histopathlogy showed a proliferation of spindle cells positive for CD31, D2-40 and HHV-8. Although HAART（highly active antiretroviral treatment）and chemotherapy（pegylated liposomal doxorubicin）provided temporary improvement, five months after initiation of the treatments the patient died from KS of the lung.

　〔Case 2〕A 35-year-old male Japanese was diagnosed with AIDS and KS, which was found on endoscopy from the esophagus to the ascending colon. Histopathlogy showed a proliferation of spindle cells positive for CD31,CD34 and HHV-8. HAART has had a favorable influence on HHV-8 replication inhibition, and the patient has achieved complete remission of KS.