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Stomach and Intestine(Tokyo) Volume 8, Issue 2 （February 1973）

胃と腸 8巻2号（1973年2月発行）

Japanese English

今月の主題消化管の悪性リンパ腫

主題

消化管の悪性リンパ腫―41症例と文献的考察 Malignant Lymphoma of the Gastro-intestinal Tract: Report of 41 cases and review of the literature 中村恭一 ¹ , 菅野晴夫 ¹ , 熊倉賢二 ² , 高木国夫 ³ K. Nakamura ¹ , H. Sugano ¹ , K. Kumakura ² , K. Takagi ³ ¹癌研究会癌研究所病理部 ²癌研付属病院内科 ³癌研付属病院外科 ¹Dept. of Pathology, Cancer Institute ²Dept. of Int. Med., Cancer Institute Hospital ³Dept. of Surgery, Cancer Institute Hospital pp.177-186

発行日 1973年2月25日 Published Date 1973/2/25

DOI https://doi.org/10.11477/mf.1403108359

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Abstract 文献概要
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　悪性リンパ腫Malignant lymphomaとは，リンパ細網細胞組織由来の悪性腫瘍の総称で¹⁾．一般的にリンパ肉腫Lymphosarcoma，細網細胞肉腫Reticulum cell sarcoma，ポジキン氏病Hodgkin's diseaseを包括している．したがって，このような腫瘍の発生は当然のことながらリンパ腺に最も頻度が高いのであるが，リンパ腺以外のリンパ細網組織lymphoreticular tissueを部分的に含む臓器にも発生する．Hellwig（1947）²⁾は，全悪性リンパ腫130例のうち2/3がリンパ腺起源で，他1/3のうち扁桃・鼻咽腔が26例，消化管19例で，残りはそのほかの臓器に分散していて発生頻度には優劣が認められないと述べている．また，Freemanら（1972）³⁾によるリンパ腺以外の悪性リンパ腫の発生部位の比較では，消化管原発なかでも胃原発の頻度が最も高く，次いで扁桃・鼻咽腔の順となっている．このように，悪性リンパ腫のリンパ腺あるいはリンパ装置が主たる臓器（Waldeyer's ring）以外の好発部位は消化管であるといえる．

　一方，消化管の悪性腫瘍ということで条件づけられた集合の組織型別頻度は，癌腫の頻度が圧倒的に高く，次いで悪性リンパ腫の順であるが，たかだか1～4％占めるにすぎない⁴⁾．

　A clinico-pathological study has been made of 41 cases of primary malignant lymphoma of the gatrointestinal tract resected at the Department of Surgery, Cancer Institute, during the past 26 years 1946-1971, together with a review of its literature.

　1. Of 41 cases, the stomach was the site of origin in 31 cases, small intestine in 3, colon in 2, and in 5 cases malignant lymphoma coexisted in the stmach and intestine. Of these 5 cases, 2 were regarded as double malignant lymphomas of the stomach and intestine. Its distribution in our series follows the same tendency seen in the literature. Its predilection sites are the stomach and the ileum. The colon is far less, and the rectum is least, often involved.

　2. Malignant lymphoma of the gastro-intestinal tract favors the age groups 50～69, as is the same with other malignant neoplasms of the gastrointestinal tract, but predilection of malignant lymphoma of the small intestine for small children has been reported in the literature.

　3. Of 41 cases of malignant lymphoma, reticulum cell sarcoma accounted for 35 cases, lymphosarcoma for 5 and Hodgkin's sarcoma for 1. In the literature the incidence of malignant lymphoma as classified according to histologic types shows that, as compared with Japan, lymphosarcoma is a little oftener encountered in the United States and Europe than reticulum cell sarcoma.

　4. Histologic differentiation of malignant lymphoma from hyperplasia of lymphoreticular hyperplasia has also been briefly discussed. This distinction forms the basis of solving the problem of malignant change of lymphoreticular hyperplasia. It remains to be solved in future.

　5. As for the question how gastric ulcer is involved in malignant lymphomatous change it, would be most appropriate to consider that the majority of lesions in which ulcer is in spatial overlapping with malignant lymphoma is caused by ulceration of lymphomatous growth.

　6. The prognosis of malignant lymphoma of the gastrointestinal tract is said in the literature to be better than its cancer. In our series of 41 cases, five-year survival was seen in 8 cases.