消化管病変を契機に発見され，種々の形態の小腸微小病変を伴った急性型adult T-cell leukemia（ATL）の1例

Acute Adult T-cell Leukemia (ATL) with Various Formed Minute Ulcers, Diagnosed in a Gastrointestinal Radiography, Report of a Case

要旨　患者は58歳，男性．発熱の原因精査のため上下部消化管検査を施行したところ，上部小腸に，一部に中心陥凹を有す多発性の小結節状隆起が認められた．また小腸二重造影にてPeyer板に一致して微小潰瘍が描出された．終末回腸には大型の不整形潰瘍とPeyer板内のアフタ様潰瘍を，大腸にもアフタ様潰瘍を認め生検にて異型リンパ球の浸潤を認めた．末梢血に特徴的な異型リンパ球の増殖と抗HTLV-1抗体陽性，proviral DNA陽性より，原疾患はATLでその消化管浸潤と診断した．上部小腸の粘膜下腫瘍様の腫瘤形成性小隆起病変は以前報告した症例と酷似しており，ATLに特徴的な所見と考えられた．また，生体における小腸二重造影法でPeyer板や微小潰瘍，孤立リンパ濾胞の描出されたATL症例の報告はなく，ATLの小腸病変の機序を考える上で貴重な画像と考えられる．

　A 58-year-old man was admitted to our hospital for further evaluation of fever of unknown origin. Small intestinal radiography revealed multiple small nodules with central depression in the upper jejunum. Double contrast small intestinal radiography was carried out continuously and multiple minute ulcers according to Peyer's patch were revealed. Total colonoscopy revealed aphtoid ulcers and invasive atypical lymphoid cells were found in the biopsy specimens. Morphologically atypical lymphocytes were found in peripheral blood and anti HTLV-1 antibody was positive. Using proviral DNA, the patient was diagnosed as having adult T-cell leukemia (ATL) and the intestinal findings were considered to be invasive lesions. The submucosal tumor-like small nodules were remarkably similar to those reported in a previous case report of the gastrointestinal lesion of ATL. Moreover, this is the first report of a patient with ATL which was diagnosed using the double contrast method of small intestinal radiography. Therefore, these findings should be reported for the light they sled on the mechanism of invasion in the patients with ATL.