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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

症例

小腸の悪性リンパ腫 Malignant Lymphoma of the Small Intestine 中村裕一 ¹ , 谷啓輔 ¹ , 中村勁 ¹ , 藤原侃 ² , 増田信生 ² , 南家邦夫 ² , 八尾恒良 ³ , 渡辺英伸 ⁴ , 岡部治弥 ⁵ Y. Nakamura ¹ , T. Fujiwara ² , T. Yao ³ , H. Watanabe ⁴ , H. Okabe ⁵ ¹福岡市医師会病院 ²佐田外科病院 ³九州大学第2内科 ⁴九州大学第2病理 ⁵北里大学内科 ¹Fukuoka Medical Association Hospital ²Sata Hospital ³2nd Dept. of Int. Med., Faculty of Med. Kyushu Univ ⁴2nd Dept. of Pathology, Faculty of Med. Kyushu Univ ⁵Dept. of Int. Med. Kitasato Univ pp.209-215

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

DOI https://doi.org/10.11477/mf.1403108365

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Abstract 文献概要
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　小腸原発の腫瘍は良性悪性ともに発生頻度は少く，田井¹⁾は全消化管腫瘍の0.025～0.09％と述べている．中村²⁾は癌研での1946年から1968年までの23年間の腸管手術例中の悪性腫瘍は560例で，そのうち小腸悪性腫瘍は25例に過ぎず，胃，大腸に比較して非常に少い事を報告している．また本邦における小腸の癌と肉腫の頻度は略々同数であるが，肉腫のうち半数は平滑筋肉腫であるので，悪性リンパ腫の頻度はきわめて少い事になる²⁾．消化管における悪性リンパ腫の分布について，Wood³⁾は小腸は胃，大腸の約2倍，M. S. Naqvi⁴⁾et al.は190例中胃116例（61％）小腸56例（30％）大腸18例（9％），Walter, J. Loehr⁵⁾et al.は胃63％，小腸25％，大腸10％と報告しており，全消化管の悪性リンパ腫のうち小腸は25～50％の頻度と考えられる．

　われわれは小腸に原発した悪性リンパ腫4例を経験しているが，全症例の病歴，他覚所見および手術または剖検所見等を一括して表1に示し，手術で切除可能であった症例1および2について詳述する．

　Four cases of malignant lymphoma are reported here that arose primarily from the small intestine.

　Case 1: A woman aged 71 came to our hospital on account of abdominal pain and emacipation. A movable tumor was palpated then on the right side of the umbilicus. It was as large as a man's fist. X-ray examination revealed in the middle part of the small intestine irregular rigidity of the marginal contour with a picture of mucosal destruction. The resected segment showed a 15 cm long tumor. Histologically it was lymphocytic lymphosarcoma. Although two metastases were seen in the regional lymph nodes, she is in good health two years after the operation.

　Case 2: A 43-year-old woman, who had complained of intermittent pain in the upper abdomen of seven months' duration, was found by x-ray to have an oval shadow defect 5 cm in the greatest diameter in the proximal part of the ascending colon. At laparotomy, a tumor located in the distal part of the cecum was found to have caused intussusception in the ascending colon. Ileocececotomy revealed a polypoid tumor, measuring 3.5×3.5×2.7 cm, in the cecum 8 cm proximal from the ileocecal valve. Histologically it was lymphoblastic lymphosarcoma with metastases to the regional lymph nodes.

　Case 3: A 16-year-old boy had been ill since one year before. He was finally hospitalized on account of abdominal pain and fever. Before the admission he had twice undergone resection of the terminal part of the ileum. After hospitalization his general condition became increasingly worse. Three months later he died from hematemesis and melena. Necropsy disclosed reticulum cell sarcoma primarily of intestinal origin with metastases throughout the body.

　Case 4: A woman at age 64 had been ill since two years and three months before. With chief complaints of high temperature and diarrhoea she was hospitalized, but she soon died from hematemesis and melena. Necropsy showed reticulum cell sarcoma presumably arising primarily out of the small intestine. General metastases were noted. In all cases here presented, x-ray study failed to make an accurate diagnosis of malignant lymphoma.