有茎性の回腸末端原発びまん性大細胞型B細胞リンパ腫の1例

Pedunculated Primary Diffuse Large B-cell Lymphoma of the Terminal Ileum, Report of a Case

要旨●患者は40歳代，男性．便潜血検査陽性にて当科を受診した．下部消化管内視鏡検査では上行結腸に潰瘍を伴う30mm大の多結節性の隆起性病変を認めた．NBI併用拡大観察やクリスタルバイオレット染色では明らかな腫瘍性変化を認めなかった．大腸X線造影検査では有茎性の大小不同の多結節性病変を認め，バリウム注入時には蟹爪様所見を呈し，送気にて回腸内への重積を来した．生検では肉芽組織のみ認められた．以上の結果より過誤腫性ポリープを考慮し，重積を起こしている経過から回盲部切除術を施行した．病理組織学的および免疫組織化学的に当該病変はびまん性大細胞型B細胞リンパ腫と診断された．有茎性のまれな形態を呈した病変であり，報告する．

　A man in his 40s presented to our department with fecal occult blood. Lower gastrointestinal endoscopy revealed a 30mm-sized multinodular elevated lesion with ulcerative colitis on the surface of the ascending colon. Narrow-band imaging and crystal violet staining showed no clear neoplastic changes. Colonic X-ray revealed pedunculated multinodular lesions of varying sizes. Barium injection revealed crab's claw-like appearance and ileal intussusception due to insufflation. Biopsy showed only granulation tissue. Therefore, ileocecal resection was performed with careful consideration of the hamartomatous polyp resulted from intussusception progression. Histologically, the lesion was consistent with diffuse large B-cell lymphoma. We herein report a pedunculated lesion with a rare morphology.