全身性悪性リンパ腫の消化管病変―画像診断を中心に

Digestive Tract Lesions of Systemic Malignant Lymphomas : Especially on Morphological Aspects

全身性悪性リンパ腫における消化管浸潤病変の肉眼形態は多彩であるが，びまん浸潤型の形態であるMLP型，腸炎類似型，巨大皺襞型を示すものが多い．MCLの消化管浸潤は，胃が最も多く，次いで結腸病変が多いが，食道病変は少ないとされている．胃病変は多彩であり，表層型，皺襞腫大型，腫瘤（隆起）型，MLP型などを呈する．一方，十二指腸から大腸にかけてはMLP型が大半を占めるが，一部に腫瘤（隆起）型も認められる．食道でもMLP型が大半を占める．FLは十二指腸から小腸に好発し，多くは多発する白色顆粒状隆起の集簇として認められるがMLPの肉眼形態を示すこともある．ATL/Lの消化管浸潤病変の肉眼形態はMLP以外に多発する表層型（0-IIc様）や肥厚型などが挙げられている．

　While there are various morphological types of gastrointestinal infiltrating lesions in systemic malignant lymphomas, the following types are commonly observed : which are diffuse infiltrating type. MLP（multiple lymphomatous polyposis）, enteritis-like, and giant fold lesions. In the gastrointestinal tract, the stomach is the most common site of mantle cell lymphoma, followed by the colon ; esophageal lesions are relatively uncommon. Stomach lesions are diverse and include the following types : superficially spreading, giant fold, mass forming, and MLP. Meanwhile, MLP lesions account for the majority of lesions from the duodenum to the large intestine, but mass forming lesions may also be seen in some areas. MLP lesions also account for the majority of lesions in the esophagus. Follicular lymphoma frequently occurs in the duodenum to the small intestine, with many instances observed as groupings of white granular protrusions ; MLP gross morphology may also be observed. The morphologies of adult T-cell leukemia/lymphoma gastrointestinal infiltrating lesions other than MLP include superficially spreading（resembling type IIc）and mucosal hypertrophic lesions.s.