骨盤内および両側副腎の同時性異所性びまん性大細胞型B細胞性リンパ腫

Synchronous double diffuse large B-cell lymphoma of pelvic and bilateral adrenal glands : a case report

　64歳男性．左腰背部痛で当科を受診．CTで骨盤内腫瘍と左水腎症，および両側副腎腫瘍を認めた．経会陰的骨盤内腫瘍生検および左尿管ステント留置術を施行した．病理組織学的検査の結果CD5陽性びまん性大細胞型B細胞リンパ腫（diffuse large B cell lymphoma : DLBCL）と診断した．EPOCH-R療法を3コース施行するも末梢神経障害が生じたためCHASE-R療法に変更した．2コース施行後のCTでの評価では部分奏効であった．

Abstract

A 64-year-old man came to our department with left lumbargo and lower abdominal pain. CT revealed pelvic and bilateral adrenal tumors and left hydronephrosis. Although PSA was in normal range, the pelvic tumor was adjacent to the prostate gland, and he underwent pelvic tumor biopsy via perineal and was inserted of the ureteral stent on the left ureter. The histological examination revealed malignant B-cell lymphoma. He was started on tirabrutinib. However, he returned to our department because of dysuria caused by the tumor's rapid growth. After a CT-guided adrenal tumor biopsy, the final diagnosis was CD 5-positive DLBCL. Three courses of EPOCH-R therapy were performed. Because of grade 3 neuropathy, CHASE-R therapy was performed subsequently. Two courses of CHASE-R therapy were performed, and partial response was achieved. Since the prognosis of CD5-positive DLBCL is poor, the patient is scheduled for autologous peripheral blood stem cell transplantation and chemotherapy (Rinsho Hinyokika 77 : 655-658, 2023).