大腸原発悪性リンパ腫を併発した潰瘍性大腸炎の1例

Malignant Lymphoma of the Colon in Ulcerative Colitis, Report of a Case

要旨　13年間の病悩期間を有する潰瘍性大腸炎に大腸原発悪性リンパ腫を併発した1例を経験した．患者は37歳，男性．咳，腹満感，全身倦怠感，上腹部痛，体重減少を主訴として入院．注腸造影でback wash ileitisを伴う全大腸型の潰瘍性大腸炎の所見に加え，横行結腸に径6.5cm大の全周性の潰瘍形成を認めた．潰瘍面の周囲粘膜への移行はなだらかであり，潰瘍部の腸管腔はむしろ拡張していた．患者は入院約1か月後に死亡し，剖検で全結腸型の潰瘍性大腸炎に併発した大動脈瘤型の横行結腸原発悪性リンパ腫（diffuse，large cell type）と診断された．同様の本邦文献報告はなく，21例の海外報告例と比較検討した．

　A 37-year-old man who had thirteen-year history of ulcerative colitis (UC) was admitted to our hospital on September 7, 1987, with complaints of cough, abdominal fullness, general malaise, abdominal pain and weight loss. Laboratory findings revealed severe inflammatory signs. Barium enema and colonoscopy showed abrormalities characteristic to UC with backwash ileitis. In addition, a large circumferential ulcer was seen in the mid-transverse colon. The surface of the ulcer, however, was relatively smooth and merged smoothly into the surrounding mucosa. The lumen at the site of ulceration was relatively distended. Endoscopic biopsy of the lesion did not lead us to the diagnosis later shown, and he was treated with anticancer drugs. He died one month after admission. An autopsy revealed marked shortening and narrowing of the entire colon and a large mass in the transverse colon. The histologic examination showed severe inflammatory cell infiltration with crypt abscess and goblet cell depletion in the entire colon except for the transverse colon. The histology of the tumor in the transverse colon showed diffuse infiltration of large atypical lymphocytes involving all layers of the colonic wall. Thus histologic diagnosis was malignant lymphoma (aneurysmal type) in UC in the active stage. Twenty-one cases have been reported in foreign literature, however, there have been no report on malignant lymphoma in UC in domestic papers.