濾胞性リンパ腫の診断と治療―診断

Clinical and Endoscopic Features of Follicular Lymphoma in the Gastrointestinal Tract

2001年1月～2013年3月までの間に，当院で経験した消化管濾胞性リンパ腫（follicular lymphoma ; FL）29例の臨床的特徴と内視鏡画像所見の特徴について述べ，診断ストラテジー，生検診断の問題点について概説した．消化管FLは十二指腸にとどまらず，空腸・回腸に多発することが多いため，範囲診断に小腸内視鏡検査による全小腸の観察が有用である．リンパ濾胞過形成との鑑別が困難な病変やstep biopsyで初めてリンパ腫と診断される症例も存在することから，内視鏡検査時には質の高い生検を行い，病理医との密なコミュニケーションが必要である．また，分子生物学的検査も診断に有用である．

　To elucidate clinical and endoscopic features of primary GI-FL（gastrointestinal follicular lymphoma）, we evaluated 29 cases of GI-FL during 2001―2013. Typical endoscopic features of GI-FL in the duodenum were multiple, whitish, small polyps and whitish granules. Because FL lesions were also detected in the jejunum and ileum in many patients, total enteroscopy, including DBE（double-balloon enteroscopy）and CE（capsule endoscopy）, should be performed in all patients. Endoscopic findings in the jejunum and ileum were different from those in the duodenum, and in some cases, it was difficult to diagnose FL on the basis of endoscopic findings alone. Therefore, endoscopists should perform a precise biopsy to obtain sufficiently large specimens for histopathological diagnosis of FL. Collaboration with pathologists will lead to an accurate diagnosis of GI-FL, and molecular techniques may be useful as well in this regard.