全消化管にmultiple lymphomatous polyposis of the gastrointestinal tract様病変を認めた全身性悪性リンパ腫の1例

Systemic Malignant Lymphoma Affecting the Alimentary Tract with Multiple Lymphomatous Polyposis-like Lesions, Report of a Case

要旨　患者は61歳，男性．食欲不振，下痢を主訴として来院．入院時に頸部，腋窩，鼠径部に小指頭大のリンパ節を触知した．消化管X線・内視鏡検査で，食道，胃，十二指腸，小腸に顆粒状から結節状の隆起性病変を認め，回腸末端では粗大結節状を呈していた．また，大腸には1か所の粘膜下腫瘍様病変と中心陥凹を伴うアフタ様病変が多発していた．食道，胃，回腸末端，大腸の各々からの生検病理組織標本で，非Hodgkin悪性リンパ腫，びまん性中細胞型，B細胞型と診断された．また末梢血に異型リンパ球を認め白血化した全身性悪性リンパ腫の消化管病変と考えられた．化学療法で隆起性病変はいったん軽快した．本症例の消化管病変はmultiple lymphomatous polyposis（MLP）of the gastrointestinal tractの形態を呈していた．食道病変を生前に診断しえた報告はまれであった．

　A 61-year-old male patient came to our hospital complaining of appetite loss and diarrhea. Physical examination showed that the peripheral lymph node was palpable, but hepatosplenomegaly was not noted. Peripheral blood picture showed leukocytosis of 14,200/mm³ with abnormal lymphocytes.

　Barium x-ray study and endoscopy revealed that the alimentary tract was pervaded (from the esophagus to the rectum) with multiple polypoid lesions.

　Snare biopsy of polypoid lesions in the esophagus and stomach and terminal ileum was performed leading to the histological diagnosis of non-Hodgkin's lymphoma, diffuse cell type, B-cell showed in origin. After chemotherapy, the x-ray and endoscopic findings were marked improvement.

　Thus, this case was considered to be systemic malignant lymphoma affecting the alimentary tract with multiple lymphomatous polyposis-like lesions.