消化管T細胞リンパ腫の内視鏡所見の特徴

Endoscopic and Clinicopathological Characteristics of Gastrointestinal T-cell Lymphoma

要旨●消化管T細胞リンパ腫のうち，本邦で頻度が高い単形性上皮向性腸管T細胞リンパ腫（MEITL），成人T細胞白血病/リンパ腫（ATL/L）の内視鏡像，臨床病理学的特徴について解析した．MEITLは，小腸を中心に全消化管に病巣を形成し，肉眼像は潰瘍性病変が最も多い．背景粘膜は，浮腫状または粗糙粘膜で，病理組織学的には腸管症様またはリンパ球性大腸炎様の所見を示す．ATL/Lは，臨床病型により内視鏡像に相違がみられ，リンパ腫型は腫瘤形成型，急性型は表層拡大型が多い．臓器別では，胃病変は腫瘤形成型が多く，胃癌との鑑別を要し，腸病変は腸炎類似の多発性・びまん性病変が多く，炎症性腸疾患を含めた腸炎との鑑別を要する．

　This study analyzed endoscopic and clinicopathological characteristics of the GI（gastrointestinal）tract involving MEITL（monomorphic epitheliotropic intestinal T-cell lymphoma）and ATL/L（adult T-cell leukemia/lymphoma）, which are more prevalent in Japan. The current study revealed that MEITL can form primary lesions in the entire GI tract, mainly in the small intestine, and the ulcerative lesion is the most common macroscopically. MEITL has an edematous background mucosa, with an enteropathy-like lesion or lymphocytic proctocolitis-like lesion. Conversely, the endoscopic feature of GI ATL/L is influenced by leukemic behavior, the mass-forming type is mainly found in the lymphoma type, and the superficial spreading type is mainly found in the acute type. Gastric ATL/L lesion is mainly found mass-forming type, should be differentiated from gastric cancer. Intestinal lesions is mainly found multiple and diffuse lesions, should be differentiate from enterocolitis, including inflammatory bowel disease.