経過中に小腸に再発病変を来した狭窄型DLBCLの1例—小腸悪性腫瘍との鑑別を中心に

Recurrent DLBCL Developing Small Bowel Lesion of Stenotic Type, Report of a Case

要旨●患者は80歳代，女性．腹部造影CT検査で多発する腹腔内リンパ節腫大を指摘され，左鼠径部リンパ節生検でびまん性大細胞型B細胞リンパ腫（DLBCL）と診断された．DLBCLに対して化学療法が施行され寛解となったが，4年目の経過観察目的の画像評価で上部小腸に再発病変を認めた．内視鏡検査では境界が比較的明瞭な全周性の不整形潰瘍を認めたが，潰瘍底の不整は乏しい印象であった．X線造影検査では高度の腸管狭窄を呈するものの，口側腸管の拡張は目立たなかった．腸管穿通による膿瘍形成を合併したこともあり，小腸部分切除術が施行された．病理組織学的には，潰瘍形成部に一致して中型〜大型の異型リンパ球の腫瘍性増殖を認め，免疫組織化学染色の結果と併せてactivated B-cell型のDLBCLと診断した．

　An elderly woman in her 80s was diagnosed with DLBCL（diffuse large B-cell lymphoma）, based on the findings of multiple lymphadenopathies and bioptic examination from the inguinal lymph node. She was given R-CHOP therapy and subsequently went into complete remission. However, her DLBCL recurred 4 years later, when she developed gastrointestinal lymphoma in the upper jejunum. A device-assisted enteroscopy revealed an irregular circumferential ulcerated lesion with a relatively clear margin, which could be interpreted as severe jejunal stenosis, without prestenotic dilatation under barium examination. Due to the concurrent development of an intraabdominal abscess, partial small bowel resection was performed. Histopathological examination of the resected specimens revealed infiltrative proliferation of medium- to large-sized atypical lymphocytes. The immunohistochemical findings of the resected specimens confirmed the diagnosis of DLBCL of the activated B-cell type.