消化管B細胞リンパ腫の内視鏡所見の特徴

Review of Endoscopic Findings in Gastrointestinal B-cell Lymphoma

要旨●消化管リンパ腫で頻度の高いMALTリンパ腫，濾胞性リンパ腫（FL），びまん性大細胞型B細胞リンパ腫（DLBCL），そしてマントル細胞リンパ腫（MCL）の内視鏡像について概説する．MALTリンパ腫の胃病変は表層型が多く，腸管病変は粘膜下腫瘍様隆起所見が多い．FLは十二指腸下行部のびまん性白色顆粒状隆起が特徴的である．腸管病変はリンパ濾胞増生様所見がみられ，時にMLP（multiple lymphomatous polyposis）も認められる．DLBCLは耳介様周堤を有する決潰型が特徴的である．MCLの胃病変は多彩で表層型，皺襞腫大型，隆起型，潰瘍型を呈する．腸管病変では多くがMLP所見を呈する．

　In this study, the endoscopic findings of highly frequent types of B-cell gastrointestinal lymphoma are discussed, including MALT（mucosa-associated lymphoid tissue）lymphoma, FL（follicular cell lymphoma）, DLBCL（diffuse large B cell lymphoma）, and MCL（mantle cell lymphoma）. Gastric lesions of MALT lymphoma are typically superficial spread type, whereas intestinal lesions are generally submucosal tumor-like elevated lesions. The descending portion of the duodenum with FL has a whitish diffuse and a small granular appearance. Intestinal lesions increase lymphoid follicle appearance and MLP（multiple lymphomatous polyposis）sporadically develops. DLBCL is distinguished by its ulcerative type with an auriculate ulcer mound. Gastric lesions of MCL are classified into several types, including superficial spread, giant fold, elevated lesion, and ulcerative. MLP is found in the majority of intestinal lesions.