空腸原発B細胞性悪性リンパ腫を合併し，自然消失した十二指腸T細胞性リンパ増殖性疾患の1例

Spontaneously Disappeared T-cell Lymphoproliferative Disease of the Duodenum with B-cell Type Malignant Lymphoma of the Jejunum, Report of a Case

要旨●患者は60歳代，女性．心窩部痛のため近医を受診し，上部消化管内視鏡検査（EGD）にて十二指腸潰瘍と診断された．薬物治療を受けたが改善しないため，当院へ紹介された．EGDでは十二指腸球部に潰瘍形成を伴う粘膜下腫瘍様病変を認め，生検でT細胞性リンパ腫と診断された．病期診断の目的で画像検査を施行したところ，偶然空腸に別の腫瘤が発見された．小腸内視鏡検査にて空腸に全周性の潰瘍性病変を認め，生検でDLBCLと診断された．2つの病変の関係が問題となったが，十二指腸病変は治療前に自然消失し，その後の検討でまれな消化管T細胞性リンパ増殖性疾患（T-LPD）と考えられた．空腸病変は小腸部分切除を行い，DLBCLへの形質転化を伴う濾胞性リンパ腫（FL）であった．

　A woman in her 60s with a proton pump inhibitor-resistant duodenal ulcer was referred to our hospital. Esophagogastroduodenoscopy revealed a submucosal tumor-like protruded lesion with ulceration in the first portion of the duodenum. Histological findings of lesion biopsy demonstrated a massive infiltration of small-sized atypical lymphocytes, and this lesion was diagnosed as T-cell lymphoma. Positron emission tomography revealed an abnormal accumulation in the jejunum ; single-balloon enteroscopy revealed a large ulcerative lesion in the jejunum. Biopsy specimens from this lesion were histologically diagnosed as DLBCL（diffuse large B-cell lymphoma）. The relationship of these lesions was controversial, and T-cell lymphoma in the duodenum spontaneously disappeared prior to chemotherapy. We believe that this lesion in the duodenum may be classified as an indolent T-cell lymphoproliferative disease in the gastrointestinal tract that had been proposed by Perry AM and his colleagues. Another lesion in the jejunum was surgically resected, and histological findings of the resected specimen demonstrated follicular lymphoma with transformation to DLBCL.