小腸悪性リンパ腫の肉眼分類とX線・内視鏡所見―組織分類との関連を中心に

Macroscopic Classification of Small Intestinal Lymphoma: Correlation between Radiographic and Histologic Findings

要旨　小腸悪性リンパ腫77例の肉眼型およびX線所見を組織像と対比した．組織型は低悪性度MALT型16例，immunoproliferative small intestinal disease(IPSID)2例，マントル細胞型2例，濾胞性4例，二次性びまん性大細胞型15例，一次性びまん性大細胞型18例，Burkitt型5例，リンパ芽球型3例，T細胞性12例であった．肉眼型は隆起型21例，潰瘍型31例，MLP型5例，びまん型9例，混合/その他11例であった．検討可能であった66例のX線所見は，隆起型(8例)，重積型(8例)，狭窄型(13例)，非狭窄型(13例)，動脈瘤型(5例)，MLP型(5例)，びまん型(7例)，混合/その他(7例)に分類できた．肉眼型・X線パターンと組織型との間には相関が認められ，動脈瘤型は全例高悪性度B細胞性であった．一方，びまん型はT細胞性またはIPSIDに特徴的で，予後不良であった．47例の症例は内視鏡検査で病変が観察でき，このうち33例で生検診断が可能であった．

　The relationship between the macroscopic, radiographic, and histologic findings was analyzed in 77 patients with primary gastrointestinal lymphoma with involvement of the small intestine.

　Histologically, 16 cases were low-grade mucosa-associated lymphoid tissue (MALT) lymphoma, 2 cases were immunoproliferative small intestinal disease (IPSID), 2 were mantle cell lymphoma, 4 were follicle center lymphoma, 15 were secondary diffuse large B-cell lymphoma, 18 were primary diffuse large B-cell lymphoma, 5 were Burkitt lymphoma, 3 were lympho-blastic lymphoma, and 12 cases were intestinal T-cell lymphoma. Macroscopically, 21 cases were classified as polypoid, 31 as ulcerative, 5 as lymphomatous polyposis, 9 as diffuse, and 11 as combined/other types. Radiographic patterns in 66 available cases included polypoid (8 cases), intussusception (8), stricturing (13), non-stricturing (13), aneurysmal (5), lymphomatous polyposis (5), diffuse (7), and combined/other forms (7). Some correlation was observed between the macroscopic/radiographic pattern and histologic type. The diffuse type (form) was characterized by either T-cell lymphoma or IPSID on histology, and by poor prognosis of the patients. Endoscopic examination was performed in 47 patients, and the histologic diagnosis of lymphoma was made in 33 cases prior to treatment by means of endoscopic biopsy.