食道病変を伴ったmultiple lymphomatous polyposis of the gastrointestinal tractの1例

Multiple Lymphomatous Polyposis of the Gastrointestinal Tract with Esophageal Lesions, Report of a Case

要旨　患者は19歳男性で歯痛と下顎部鈍痛を主訴とし，歯科で口腔内腫瘍を指摘され悪性リンパ腫と診断された．理学的所見では口腔底に潰瘍を伴う腫瘍があり，顎下・腋下に軽度のリンパ節腫脹を認めた．白血球数・分画に異常なく，血清IgAとPHA-BTの低下を認めた．消化管X線および内視鏡検査で食道，十二指腸，空腸，回腸に多発性の隆起性病変を認めた．各消化管の生検標本と大腸のポリペクトミー標本から非ポジキン悪性リンパ腫と診断した．本例は消化管病変を主とする病態からmultiple lymphomatous polyposis of the gastrointestinal tractと考えられるが，本疾患で生前に食道病変を観察しえた報告は非常にまれである．

　A 19 year-old man, initially visited our department of dentistry with chief complaints of a toothache and a dull pain in the submaxillary region. An ulcerated tumor was found in the oral floor which was thereby diagnosed as malignant lymphoma. Subsequent physical examination revealed minor, palpable lymphadenopathy in the submaxillary and the axillary regions. Hepatosplenomegaly was not noted.

　Peripheral blood picture was normal. The serum IgA was reduced to 38 mg/dl and the lymphocyte trasformation reaction with PHA declined to 147 (over 296 in control). Roentgenograms and endoscopic examinations revealed multiple polypoid lesions in the esophagus, duodenum, jejunum, ileum and the entire large intestine. Histological examination of the endoscopical biopsy specimen of the esophagus, duodenum, terminal ileum and large intestine and the polypectomized ones of the sigmoid colon, revealed to be non-Hodgkin's malignant lymphoma.

　From above mentioned findings, our case is consistent with multiple lymphomatous polyposis of the gastrointestinal tract by Cornes and a rare one with esophageal polypoid lesions early detected in clinical course.