膿瘍との鑑別に苦慮した後腹膜悪性リンパ腫

Malignant Lymphoma Initially as a Perirenal Tumor:A Case Report

　患者は61歳，糖尿病の男性で，発熱，全身筋肉痛を主訴に救急受診した。緊急血液検査で重症感染症およびDIC類似の所見，そして緊急腹部CTで右腎腎茎部周辺に内部は多房性で低吸収域を示す不整な腫瘤を認め，一部壁に造影効果を認めた。壁不整な腫瘤の一部は腸腰筋へ浸潤していた。糖尿病患者に多発する腎周囲あるいは腸腰筋膿瘍を初めに想定した。しかし，その後の開腹組織診断で悪性リンパ腫と診断され，化学療法としてCHOP療法を施行した。

A 61-year-old diabetic man was admitted to our hospitalcomplaining high fever and muscular pain. Laboratoryexaminations showed severe inflammatory change anddisseminated intravascular coagulation. Abdominal CTshowed a low-density mass in the right side of the retro-peritoneum, and the mass was extending into the psoasmuscle layer through Gerota's fascia. Under the diagnosisof perirenal abscess or perirenal tumor,open biopsy wasperformed and histotogical examination revealed a malignantlymphoma which was further classified as B cell diffuse,large cell type. After diagnosis, he received combinationchemotherapy (CHOP).