多彩な大腸病変を呈した成人T細胞性白血病（ATL）の1例

Adult T-cell Leukemia with Severe Gastrointestinal Invasion, Especially Bizarre Lesions in the Colon, Report of a Case

要旨　患者は59歳，男性．下痢，下血の精査加療目的で入院．血液検査で白血球数増加，核に切れ込みのあるflower cell様の異常リンパ球の出現を認めた．また，血清抗HTLV-I抗体が陽性，LDHも高値を示し成人T細胞性白血病（ATL）と診断された．消化管検査で胃および小腸にびらん，小潰瘍の多発が認められた．大腸には直腸から回盲部にびまん性に発赤の強い顆粒状隆起が拡がり，S状結腸にはびらん，小潰瘍が，また，直腸には扁平隆起が認められた．それぞれの生検組織診で末梢血と同様の異常リンパ球を認め，広範に消化管浸潤を伴ったATLと診断された．本症例の大腸病変は過去に報告をみない特異な所見を呈していた．

　A 59-year-old man was admitted to our hospital complaining of diarrhea and melena. Laboratory examinations on admission showed that white blood cell count had increased with abnormal lymphocytes with cleaved nuclei like flower cells, serum LDH was elevated, and serum anti HTLV-I antibody was positive. Therefore, we diagnosed his illness as adult T-cell leukemia (ATL). Radiologic and endoscopic examinations of the gastrointestinal tract revealed multiple erosions and small ulcers in the stomach and the small intestine. Severe reddish granular elevated lesions in the entire colon were observed. In addition, erosions and small ulcers in the sigmoid colon and flat elevated lesions in the rectum were observed. Histological examinations of the specimens from these lesions showed diffuse infiltration of abnormal lymphocytes similar to those in the peripheral blood. Thus, the patient was diagnosed as ATL with severe gastrointestinal involvement. We report this interesting case, because the gastrointestinal appearance, especially in the colon, was various and bizarre, and has never been reported.