十二指腸原発悪性リンパ腫の1例

Primary non-Hodgkin's Lymphoma of the Duodenum, Report of a Case

要旨　患者は63歳，男性．心窩部不快感，下血のため施行した上部消化管X線および内視鏡検査にて，十二指腸下行脚に全周性狭窄を伴う隆起性病変を指摘された．低緊張性十二指腸造影では，最狭窄部に潰瘍を疑わせるニッシェを認めるものの，その口側と肛門側の粘膜面はほぼ保たれ，いわゆる全周性の収束像を呈していた．生検にて，B細胞性悪性リンパ腫と診断された．膵頭十二指腸切除術を施行後，化学療法と放射線療法が追加された．手術組織結果は，びまん性悪性リンパ腫，大細胞型，B細胞性（IgM・κ）であった．術後の化学療法は8クール施行され，術後4年2か月経過した現在も再発の兆候は全くなく，健在である．

　A 63-year-old man was admitted with the complaint of epigastric discomfort and melena. Radiographic and endoscopic findings revealed severe narrowing of the duodenal second portion. The most narrow segment showed ulceration and hemorrhage, and the fiberscope could not pass this area. The other mucosa was intact and swollen. Histology of the biopsy specimen revealed malignant lymphoma.

　Computed tomography showed a duodenal mass with regional lymphadenopathy. Bone marrow aspiration revealed normal marrow. Our patient was treated by pancreatoduodenectomy.

　Although the resected specimen showed a thickening of the duodenal wall, the mucosa, except for the severely narrowed part, was almost intact. Final histological diagnosis was primary non-Hodgkin lymphoma (diffuse, large-sized, B-cell type) of the duodenum. After postoperative chemoradiotherapy, the patient has been alive for four years and two months without recurrence.