小腸・大腸DLBCLの診断と治療―治療

Treatment for Diffuse Large B-cell Lymphoma in the Small and Large Intestine

小腸・大腸DLBCLについて自験例を提示し，治療について概説した．当科の症例は小腸DLBCL 7例，大腸DLBCL 2例で，全例手術が行われており，5年生存率は83％と良好であった．小腸・大腸DLBCLへの対処は，診断と治療をかねて，可能であれば病変の切除を行う．切除病変を詳細に調べることでステージ分類ができ，切除することで根治の可能性が高まり，消化管合併症（穿孔や出血，閉塞）を避けることができる．Lugano国際会議分類I/II期であれば，切除後に化学療法を加える．IV期の場合，手術の適否は病変の進行具合や患者の全身状態など，個々に検討する必要がある．

　Cases of DLBCL（diffuse large B cell lymphoma）in the small and large intestine at our institution were reviewed with reference to the literature. We treated 7 patients who had DLBCL in the small intestine and 2 in the colon. Surgical resection was performed in all cases, and the 5-year survival rate was 83%. In the management of DLBCL in small and large intestines, surgical intervention should be used for both diagnosis and treatment. Analysis of the resected lesion can help in accurate staging. Resection will increase the probability of a cure and minimize the risk of intestinal complications such as perforation, bleeding, and obstruction. When the tumor is classified as Lugano stage I/II, chemotherapy should be administered after surgical resection. With stage IV, the treatment strategy should be determined on the basis of the tumor size, histopathological features of DLBCL, and the physical status of the patient.