原発性小腸悪性リンパ腫のX線および内視鏡所見―切除標本病理所見との対比を中心に

Radiographic and Endoscopic Features of Primary Malignant Lymphoma of the Small Intestine: Comparison with Pathological Findings of the Resected Specimens

要旨　原発性空回腸悪性リンパ腫26例32病変の小腸二重造影像と内視鏡所見を検討し，切除例20例23病変についてはX線所見と切除標本病理所見とを比較検討した．32病変の二重造影像は，①Ⅰ型：病変部と非病変部の腸管幅が不変で，扁平な隆起（Ⅰa）あるいは半球状の隆起（Ⅰb）を認めるもの（7病変），②Ⅱ型：高度の狭窄を示すもの，③Ⅲ型：中等度の管状狭窄を示すもの（5病変），④Ⅳ型：病変部腸管幅が非病変部に比しわずかに小さい（Ⅳa）か，ほぼ同等（Ⅳb）か，わずかに大きい（Ⅳc）が，病変部の粘膜面は無構造であるもの（2病変），⑤Ⅴ型：病変部腸管幅が非病変部に比し両側性（Ⅴa）あるいは偏側性（Ⅴb）に明らかに大きいもの（4病変），⑥Ⅵ型：びまん性に皺襞腫大を認め，散在性に狭窄像を伴うもの（2病変），⑦Ⅶ型：びまん性に皺襞腫大と微細顆粒状隆起を認めるもの（2病変），⑧Ⅷ型：腸重積像（5病変），⑨混合型（5病変），に分類できた．これらX線パターンと割面像を含む切除標本肉眼所見とはよく合致した．内視鏡検査は10例で施行されていたが，特にⅦ型病変に対するプッシュ式小腸ファイバースコープ検査は有用であった．以上の成績より，本症の診断上小腸二重造影法と内視鏡検査が極めて重要であると考えられた．

　Study was conducted regarding radiographic and endoscopic features of primary malignant lymphoma of the jejunum and ileum in 26 patients (32 lesions). The radiographic features were also correlated with pathological findings of the resected specimens. Radiographic appearances as seen by double contrast technique were divided into the following nine groups (Fig. 1):

　1) The size of the lumen is normal but small (Ia) or large (Ib) polypoid lesions are seen (Type I, 7 lesions).

　2) Severe narrowing of the lumen is seen (Type II).

　3) Tubular narrowing of the lumen is demonstrated (Type III, 5 lesions).

　4) Normal mucosal pattern is lost but the size of the lumen is almost normal (Type IV, 2 lesions).

　5) There is a large and deep ulceration causing remarkably increased size of the lumen (Type V, 4 lesions).

　6) Kerckring's folds are diffusely thickened with scattered strictures (Type VI, 2 lesions).

　7) There are coarse mucosal patterns consisting of innumerable fine granular radiolucencies, and diffuse thickening of the folds (Type VII, 2 lesions).

　8) Intussusception is demonstrated (Type VIII, 5 lesions).

　9) Two or more patterns are seen (Mixed type, 5 lesions).

　There was a good correlation between radiographic appearances and macroscopic findings of the resected specimens including cross section of the lesion. Endoscopy of the small intestine was performed in 10 patients, in 9 of whom it was useful for the diagnosis. Especially, push-type small intestinal fiberscopy was of use in diagnosing Type VII lesions. Our results suggest that double contrast study and endoscopy of the small intestine are essential to the definitive diagnosis of this disease.