小腸全体にNodular Lymphoid Hyperplasiaを合併した十二指腸細網肉腫の1症例

Reticulum Cell Sarcoma of the Duodenum Associated with Nodular Lymphoid Hyperplasia of the Small Intestine

　十二指腸細網肉腫は比較的稀な疾患であるが，最近われわれは免疫グロブリンの異常と小腸全体におよぶ良性のNodular Lymphoid Hyperplasiaを合併した稀有な症例を経験したので，文献的考察を加えて報告する．

　A 31-year-old male was admitted to our hospital because of tarry stool and jaundice. The abdomen was tender on palpation in the right upper quadrant and epigastrium, but no masses were palpable.

　Labolatory data revealed moderate hypochromic anemia and obstructive jaundice. Results of glucose tolerance test and pancreozymin-secretin test suggested some pancreatic damage. Immunoelectrophoresis showed marked decrease of IgA and IgM components.

　No abnormality was seen in the X-ray findings of the esophagus, stomach and colon. Hypotonic duodenography revealed irregular rigidity of the marginal contour in the 2nd portion of the duodenum with a large irregular ulceration at the periampullary region. In addition, innumerable tiny nodular filling defects of uniform size and shape, approximately 2 mm in diameter, were diffusely distributed from the 3rd portion of the duodenum to the terminal ileum.

　Duodenofiberscopy was performed and a diagnosis of malignant lymphoma was made in the biopsy specimens taken from the shallow ulcer at the periampullary region.

　Pancreatico-duodenal resection was performed and some specimens were taken from the jejunum and ileum for pathological examination. The tumor was confirmed by histological examination as reticulum cell sarcoma originated from the duodenal mucosa, slightly invading the adjacent pancreatic tissue. Tiny polypoid lesions of the small intestine were due to benign hyperplastic lymph follicles within the lamina propria mucosae. The overlying mucosal epithelium was normal or partially eroded.

　The lymphoid hyperplasia in this case is identical with Hermans' report (1966) of the name of “Dysgammagloblinemia Associated with Nodular Lymphoid Hyperplasia of the Small Intestine”.

　This reported case with reticulum cell sarcoma of the duodenum was accompanied by nodular lymphoid hyperplasia of the small intestine although both diseases are quite rare.