胃原発の加齢性EBV関連B細胞リンパ増殖症の1例

Primary Gastric EBV Positive DLBCL of the Elderly, Report of a Case

要旨　患者は68歳，男性．2002年7月，腹痛を主訴に当院へ紹介となった．上部消化管内視鏡検査にて胃体上部から前庭部に不整形潰瘍が多発し，CT検査にて腹腔内に複数のリンパ節腫大を認めた．胃生検よりDLBCLと診断され，腫瘍細胞はEBER-ISH陽性であった．Lugano国際会議分類II2期でありCHOP療法8コースで完全奏効を得たが，治療後3か月で再発し救援療法の効果なく初回診断後11か月で死亡した．本症例は胃原発の加齢性EBV関連B細胞リンパ増殖症である．加齢性EBV関連B細胞リンパ増殖症は，加齢に伴う何らかの免疫機能低下の関与が示唆されるDLBCLの一亜型であり，通常のEBV陰性DLBCLより予後不良である．

　A 68-year-old man was admitted to Aichi Cancer Center hospital complaining of epigastric pain in July 2002. Endoscopic examination of the stomach revealed multiple ulcerative lesions with irregular shape from the gastric upper body to the antrum. CT scan showed multiple abdominal lymphadenopathy including para-aortic lymph nodes. Histological findings of the endoscopic biopsied specimens showed that it was diffuse large B-cell lymphoma. Lymphoma cells were positive for EBER-ISH（EBV-encoded small non-poly-adenylated RNA in situ hybridization）. Considering that his age was over 50 without underlying immunodeficiency, he was diagnosed as primary gastric EBV-positive diffuse large B-cell lymphoma of the elderly with stage II2 by the Lugano staging system. Although a complete remission was achieved after eight courses of CHOP therapy, the patient relapsed three months after the last chemotherapy. The patient died 11months after initial diagnosis due to poor response to salvage therapies. Patients with EBV（Epstein-Barr virus）positive DLBCL（diffuse large B-cell lymphoma）of the elderly, which may be associated with immune senescence in the elderly, have a worse prognosis than those with EBV-negative DLBCL.