診断に苦慮した狭窄を合併した小腸MALTリンパ腫の1例

Ileal Mucosa-Assisted Lymphoid Tissue Lymphoma with Intestinal Stricture：Report of a Case

要旨●患者は70歳代，男性．意識消失を契機に近医を受診し，Hgb 9.0g/dLの貧血を認めたため，別の医療機関を受診した．EGD，大腸内視鏡検査を施行するも出血源を認めず，造影CTを撮影したところ小腸壁肥厚を認め，精査目的に当科へ紹介され受診となった．DBEを施行したところ，下部小腸に求心性の膜様狭窄とその口側に亜全周性の潰瘍を認めた．生検で悪性所見を認めず，1か月後にDBEを再検したところ，前回同様の所見であった．再度生検を施行したが確定診断がつかず，各種検査から悪性リンパ腫も否定できないこと，スコープが通過困難な狭窄であったことから，回腸部分切除を施行した．病理組織学的所見からMALTリンパ腫と診断した．術後2年間無再発で経過観察中である．

　A 77-year-old male was referred to our department because of anemia with 9.0g/dL hemoglobin. He underwent esophagogastroduodenoscopy and colonoscopy without revealing any bleeding source. A computed tomography scan detected small intestinal wall thickening. Retrograde double-balloon endoscopy revealed an afferent membranous stricture in the ileum and subperipheral ulceration at the oral side of the ileal stricture. Biopsy specimens revealed no malignant findings, and double-balloon endoscopy was reperformed after one month, with similar results. A second biopsy specimen revealed no specific results. Thus, a definitive diagnosis could not be made. Partial ileal resection was performed because malignant lymphoma could not be ruled out based on various examinations and the ileum lumen was narrowed. A mucosa-assisted lymphoid tissue lymphoma was diagnosed based on the histopathological findings of the surgical specimen. The patient has been under postoperative observation for two years without recurrence.