十二指腸に特徴的な所見を認めた急性型adult T-cell leukemia（ATL）の1例

Adult T-cell Leukemia Accompanied by Typical Diffuse Gastroduodenal and Small Intestinal Lesions, Report of a Case

要旨　患者は34歳，男性．心窩部痛，腹部膨満を主訴に来院．表在リンパ節腫脹，肝脾腫を伴い，腹部超音波検査で腹腔内リンパ節腫大を認めた．血液検査では異型リンパ球を伴う白血球増多，LDH，血清カルシウムの高値がみられた．消化管検査では胃幽門部に軽度のびらん，十二指腸球部～第2部にかけて大小の周辺隆起を伴う表面赤褐色調のⅡa＋Ⅱc様病変が多発していた．また，空腸から回腸には中心陥凹を有する小隆起が多発し，回腸末端には潰瘍性病変が認められた．以上から，ATLの消化管病変と診断した，本症例は十二指腸，小腸主体の消化管浸潤を呈したATLの1症例であり，特に十二指腸に特徴的な所見を認めたため報告した．

　A 34-year-old man was admitted to our hospital complaining of epigastric pain and abdominal distension. Swollen superficial lymph nodes and marked hepatosplenomegaly were palpated. Laboratory examination revealed leukocytosis with atypical lymphocytosis and elevated serum calcium and LDH. Upper gastrointestinal endoscopy showed mild erosions in the stomach and several reddish flat eletated lesions (Ⅱa+Ⅱc-like) in the bulb and the second portion of the duodenum. Radiologically, small and flat elevated lesions with central depression were recognized from the jejunum to the ileum. A solitary ulceration with irregular margin was detected near the terminal ileum. These peculiar lesions were considered to be the distinguishing features of the duodenal invasion of adult T-cell leukemia.