血液疾患における上部消化管病変の特徴

Radiological and Endoscopic Features of Upper Gastrointestinal Lesions in Patients with ATL and Schönlein-Henoch Purpura

要旨　血液疾患のうち，消化器症状を契機として発見されることが多い成人T細胞白血病の上部消化管病変の特徴について検討した．消化器症状を初発とした成人T細胞白血病6例のX線・内視鏡像および病理所見を呈示し，文献例と合わせ考察した．成人T細胞白血病の食道病変は剖検例では認められるが，X線・内視鏡検査では指摘できなかった．文献例でも報告がなかった．胃病変は全身性悪性リンパ腫や原発性胃悪性リンパ腫と同じ肉眼型を示した．そのほか，“小結節集簇型”病変も文献例でみられた．十二指腸病変は，一部に中心陥凹を有す，多発性の小結節状隆起としてみられた．上部消化管検査で悪性リンパ腫の所見を認めたら，成人T細胞白血病の病変の可能性も考慮し，検索していく必要があると考えられた．また，アレルギー性疾患であるが，腹部症状の著明であったSchönlein-Henoch紫斑病2例についてもX線・内視鏡像を呈示した．

　Digestive symptoms are rare as the first symptoms of blood diseases. However, it is not the case in patients with adult T-cell leukemia (ATL). ATL is often found with complaints of digestive symptoms.

　We demonstrated radiological, endoscopic and pathological findings of the upper gastrointestinal (GI) lesions in six patients with ATL who had digestive symptoms at the onset of the disease, and then tried to illustrate these findings by discussing other reported findings.

　Although esophageal involvement was proved in autopsied materials, neither radiological nor endoscopic examinations were useful to detect the lesions in ATL patients. As far as we know, there have been no reports that esophageal involvement was found by these methods.

　In our study, gastric lesions in ATI. patients were macroscopically similar tothose in patients with systemic malignant lymphoma or primary gastric malignant lymphoma. The results were consistent with other reported cases. There was one report that showed the gastric mucosal lesion which was composed of multiple aggregated nodules.

　Duodenal lesions were macroscopically found to assume the form of multiple nodules with several central depressions.

　These results suggest that ATL should also count as one of the possible differential diagnoses when we recognize malignant lymphoma by radiological or endoscopic examinations in the upper GI tract.

　We added radiological and endoscopic findings of the upper GI tract in two patients with Shönlein-Henoch purpura, an allergic disease. They had complained of severe abdominal symptoms.