大腸悪性リンパ腫のX線診断

Radiological Findings of Malignant Lymphoma of the Rectum and Colon

要旨　大腸の悪性リンパ腫11例と悪性リンパ腫と鑑別が困難であった直腸病変1例を経験したので報告した．大腸の悪性リンパ腫は回盲部に多く，一部で直腸にもみられた．悪性リンパ腫のX線所見として，隆起と陥凹の所見に分けることができた．隆起の所見をみると，小さな病変ではポリープ様，中等度の病変では粘膜下腫瘤様，大きな病変では粗大結節状であった．陥凹の所見はゆるやかな陥凹面をみたものが多かった．陥凹部で腸壁の変形は比較的軽度であった．化学療法の効果と共に悪性リンパ腫のX線所見は改善した．サルコイドーシスに併発した直腸病変は悪性リンパ腫と臨床的に鑑別が難しかった．

　Eleven cases of malignant lymphoma involving the rectum and colon seen at the Juntendo University Hospital between 1977 and 1987 are reported. These cases are consisted of nine ileocecal and four rectal cases. Radiographic findings of colo-rectal lymphoma were divided into protrusive and/or concave types. A small lesion of protrusive type is demonstrated as a polypoid lesion, a middle-sized one submucosal tumor, and a large one as coarse nodular lesion. Concave type has a smooth margin and moderate distensibility of colonic wall. Based on these radiographic findings it is possible to make a differential diagnosis of lymphoma or cancer of the large bowel. Chemotherapy for the lymphoma was effective in reducing tumor or ulceration caused by lymphomatous involvement in three cases.