管外性に発育し巨大腫瘤を形成した横行結腸MALTリンパ腫の1例

Characterization of Atypical Mucosa-associated Lymphoid Tissue Lymphoma Based on Diffuse and Extreme Wall Thickening in the Transverse Colon, Report of a Case

要旨●患者は60歳代，男性．2013年11月中旬頃から頻回の水様性下痢と腹部膨満感が出現し，当センターを受診した．大腸内視鏡検査および注腸X線造影検査では横行結腸の肝彎曲部から中部にかけて軽度の進展不良を伴う全周性びまん性の粗大顆粒状粘膜面を認め，一部に縦走する潰瘍を認めた．腹部造影CT検査では腹腔内に20cm大の造影効果に乏しい腫瘍を認め，内部に横行結腸が走行していた．大腸内視鏡検査での生検組織結果から，横行結腸MALTリンパ腫と診断した．著明な管外性発育を示し，興味深いX線造影所見・内視鏡所見を呈した大腸MALTリンパ腫の症例であったため，文献的考察を踏まえて報告する．

　We present an atypical case of primary gastrointestinal MALT（mucosa-associated lymphoid tissue）lymphoma in the transverse colon. A man in his 60s was admitted to our hospital due to abdominal distension. Computed tomography showed diffuse and extreme wall thickening in the transverse colon. Furthermore, colonoscopy showed diffuse, large granular mucosa with ulcers in the transverse colon. Barium enema revealed the disappearance of haustra and irregularities on the transverse colon surface. The lesion was diagnosed as MALT lymphoma based on pathological examination of the biopsied specimen. We performed chemotherapy and Helicobacter pylori eradication therapy ; the patient achieved complete remission and has been in good condition without any evidence of recurrence.