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要旨●患者は70歳代,男性.近医のEGDにて,左梨状陥凹に12mm大の隆起性病変を認め,生検で癌と診断され当科でESDを施行した.病理組織学的には上皮下層主体にリンパ濾胞を伴う小型で密なリンパ球浸潤がみられ,びまん性にCD20陽性のB細胞主体であり,上皮の破壊像や上皮釘脚の不規則な延長も確認された.浸潤したリンパ球のIgH遺伝子のモノクローナルな再構成を確認し,最終的にMALTリンパ腫と診断した.下咽頭領域に発生するMALTリンパ腫は極めてまれであるが,リンパ濾胞との鑑別点として大きさが10mm以上であること,隆起の立ち上がりが外反あるいは比較的急峻であること,brownish areaの領域がリンパ濾胞よりも大きく,その境界は比較的明瞭であること,血管の口径不同は乏しいが血管は伸長し,配列の乱れがあることが挙げられた.また,癌との鑑別は典型的な癌の4徴を呈する乳頭内血管を認めないことであるが,生検診断のみに頼らず,内視鏡画像を詳細に評価し再生検も含めて診断する必要がある.
A man in his 70s underwent conventional endoscopy as a part of his annual evaluation during which a reddish elevated lesion, approximately 12mm in size, was found at the left piriform sinus. Histopathological analysis of the biopsy specimen revealed squamous cell carcinoma in situ and ESD(endoscopic submucosal dissection)was performed. The lesion was predominantly subepithelial, and the resected specimen displayed dense infiltration of small lymphoid cells along with diffuse positivity for CD20 immunostaining. The infiltrative tumor cells showed IgH monoclonality and a definitive diagnosis of MALT(mucosa-associated lymphoid tissue)lymphoma was made. MALT lymphoma of the hypopharynx is an extremely rare condition, and it is important to differentiate it from the lymph follicle. In particular, characteristics such as size of >10mm, steep sides of the tumor, size of the brownish tissue being larger than or distinct from that of the lymph follicles, and irregular arrangement of intra papillary capillary loop with weak caliber change may be important differentiating factors.
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