消化管悪性リンパ腫のX線診断

Roentgenologic Diagnosis of Malignant Lymphoma of the Digestive Tract

　近年，診断学の進歩と共に早期胃悪性リンパ腫の報告もみられるに至った．しかし，多くの臨床的・病理的研究にもかかわらず，未だ癌との鑑別診断は必ずしも容易とはいえない．消化管の悪性リンパ腫には，消化管に原発するものと，全身病変の部分症として消化管にも浸潤するものとの二種類がある．この両者は，少くとも臨床的にはかなり異なる病態像を示すが診断的立場から比較した報告は少ない．

　著者らは，消化管の悪性リンパ腫病変の一般的臨床像，頻度，ならびにそのX線診断について検討すると共に，原発性病変と全身性病変の部分症としての消化管病変にっいても文献的考察を加えながら比較してみた．

　During the past 10 years we have come across in our hospital 213 cases of malignant lymphoma with the digestive tract examined by ary of diagnostic methods. Their study has revealed:

　1. All cases were divided into two groups; the one in which malignant lymphoma of the digestive tract was confirmed by histological examination; and the other where ro such distinction could be made. Clinical pictures including subjective symptoms were correlated between the two groups, but no particular difference was seen between our results and those reported up to the present.

　2. Necropsy of 115 cases showed that in 51.3 per cent the malignant lesion was found somewhere in the digestive tract: esophagus, 5.2 per cent; stomach, 26.1 per cent: small intestine, 36.5 per cent and colon, 27.0 per cent.

　3. After dividing gastric lesions into the three types: tumor type, ulcer type and infiltrative type, we compared primary gastric lesion of malignant lymphoma with the secondary lesion of the stomach appearing as a local manifestation of systemic malignant changes, and some information was obtained. Roentgenologically, gastric malignant lymphoma is characterized by relatively large lesions. In only a small number was the gastric contour deformed and distensibility of the wall hindered, although the lesions were of variegated shapes. In some lesions even the depth of invasion could be estimated by x-ray study alone. We have also come across a case where lymphomatous infiltration was localized in only a part of the tumor despite general giant rugal folds.

　4. The intestinal lesions were studied on necropsied cases for the site, size and gross findings. In about 60 per cent was the ulcer type seen, most of ten in the ileum. A multiplicity of small lesions less than 3 cm in diameter was more frequent.

　5. Study of the colon in autopsied cases showed that lesions tended to be multiple in the cecum, ascending colon and sigmoid. The tumor type was a little more frequent. Examination was also done on the x-ray findings of the lesions in the intestine.

　6. Not only from the above results but also from the fact that prognosis of malignant lymphoma arising primarily from the digestive tract is relatively good, we have especially discussed on its early diagnosis and therapeutic possibility.