直腸に多発した原発性早期follicular lymphomaの1例

Primary Multiple Follicular Lymphoma of the Rectum, Report of a Case

要旨　患者は52歳，男性．便潜血反応陽性で当院受診．大腸内視鏡検査で直腸に多発する隆起性病変を認めた．注腸造影および内視鏡検査で中心に陥凹を伴った3×2cmの隆起性病変，Ⅰs型隆起，Ⅱb＋“耳介様”隆起性病変を認め，生検で悪性リンパ腫と診断．歯状線近傍まで腫瘍が存在するためMile's operationを施行した．切除標本では腫瘍は5か所に認められ，すべて早期病変（m～sm）であった．病理組織学的には腫瘍細胞が粘膜下層から粘膜固有層にかけて濾胞状ないし結節状に存在し，LSG分類における早期の直腸原発follicular lymphomaと診断された．

　A 52-year-old man visited to our hospital because of positive results for fecal occult blood. Colonoscopic examination showed multiple elevated lesions in the rectum. Barium enema and colonoscopic examination revealed a large polypoid tumor with central depression, a small sessile tumor and a flat-topped elevated lesion. Biopsy specimen obtained by colonoscopic examination suggested malignant lymphoma. Mile's resection was performed because there was a tumor near the dentate line. Five tumors were identified in the resected specimen and all of them were located in the mucosa or submucosa. Pathologically, tumor cells proliferated from the submucosal layer to the lamina propria mucosae and this case was thought to be follicular or nodular form. Consequently this case was diagnosed with the primary early rectal follicular lymphoma.