HTLV-1関連胃原発悪性リンパ腫の1例

HTLV-I Associated Primary Gastric Lymphoma, Report of a Case

要旨　患者は，63歳の佐賀県出身の女性で，心窩部痛を主訴に近医を受診した．胃内視鏡検査で，胃角部の潰瘍を指摘され，治療が行われたが，2か月後の内視鏡検査では，病変は不整な潰瘍を伴った隆起へと変化しており，そのほかに胃体部の皺襞の腫大，穹窿部の隆起性病変などを認めた．生検による病理組織学的検査で，悪性リンパ腫と診断した．更に，抗HTLV-1抗体陽性，胃の生検組織でHTLV-Ipro-viralDNA陽性で，成人T細胞白血病/リンパ腫（ATLL）と診断した．末梢血や骨髄中には，異常リンパ球は認めずHTLV-Ipro-viralDNAも陰性であった．他臓器や胃の所属リンパ節以外のリンパ節への浸潤を認めなかった．以上のことから本症例はHTLV-1関連胃原発悪性リンパ腫（胃原発ATLL）と考えられた．胃に主病変を置くATLLの報告はまれで，厳密に胃が原発と考えられる報告はなく，今回報告した．

　We reported a rare case of adult T-cell leukemia/lymphoma in the stomach. A 63-year-old woman born in Saga prefecture was admitted to a hospital complaining of epigastralgia. Endoscopic examination showed ulcerative lesions around the gastric angle. Endoscopic examination two months later exhibited variform lesions in the stomach including irregular elevated lesions with ulcerations in the angle, diffuse mucosal thickening, and a mass lesion in the fornix. Histological examination of these lesions revealed non-Hodgkin's lymphoma. Anti-HTLV-I antibody was positive in the serum and HTLV-I pro-viral DNA was positive in the biopsy sample from the stomach. Neither abnormal lymphocyte nor HTLV-I pro-viral DNA was positive in the peripheral blood and the bone marrow. Neither lymph node swelling nor metastasis to the other organs was observed in the abdominal CT-scanning and abdominal echogram. These data indicated that diagnosis of the present case was HTLV-I associated with primary gastric lymphoma.