潰瘍を呈した原発性食道悪性リンパ腫の1例

Malignant Lymphoma of the Esophagus Presenting with Deep Ulceration, Report of a Case

要旨●患者は62歳，女性．嚥下時のつかえ，胸痛を主訴に当院を受診した．食道X線造影検査で中部食道に8cmに及ぶ潰瘍を伴う腫瘤を認めた．上部消化管内視鏡検査では上門切歯列より25〜33cmに亜全周性に，辺縁が明瞭で深掘れの潰瘍性病変が存在し，狭窄を来していたが内視鏡の通過は可能であった．生検の結果，diffuse large B cell lymphomaと診断された．CT検査，ガリウムシンチグラフィーでAnn Arbor病期分類IIEA期と診断し，CHOP療法と放射線療法を行った．その後11年経過した現在も無再発生存中である．本例の潰瘍は食道癌に伴う潰瘍とは異なり，粘膜下腫瘍様周堤や境界明瞭な深掘潰瘍，比較的平滑な潰瘍底を呈し，悪性リンパ腫に特徴的所見を呈していた．

　A 62-year-old female visited our hospital with dysphagia as her chief complaint and was admitted for further examination and treatment of esophageal tumor.

　Barium swallowing revealed a tumor with deep ulceration in the middle thoracic esophagus. Endoscopy revealed an ulcerated tumor with a relative clear, smooth margin, with a diameter of 8cm. A biopsy obtained from the ulceration showed malignant lymphoma, diffuse large B-cell type.

　According to the Ann Arbor Staging System, we diagnosed the patient with stage II EA, based on the results of CT and Ga-67 scintigraphy. The patient underwent chemoradiation therapy, which resulted in complete remission. The patient is now healthy, with no evidence of recurrence after 11 years.